New Jersey Attorney General Peter Harvey announced that an Ocean County woman has been ordered by the Ocean County Superior Court to pay more than $19,000 in restitution for her reported involvement in a scheme to obtain reimbursements from Horizon Blue Cross/Blue Shield for prescription drugs that were never paid for or received.
According to Vaughn McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden Brown, Ruth Schwartz, 55, of Jackson Township, was sentenced by Ocean County Superior Court Judge James Citta to three years probation and ordered to pay $19,569 in restitution to Horizon Blue Cross/Blue Shield and to pay a $5,000 civil insurance fraud fine pursuant to the Insurance Fraud Prevention Act.
Gooden Brown noted that Schwartz was charged via a State Grand Jury indictment with Health Care Claims Fraud and theft by deception. Schwartz pleaded guilty before Judge Citta on June 16, reportedly admitting that she submitted 121 prescriptions to 26 pharmacies for various prescription drugs. The prescriptions were submitted under Schwartz’ husband’s prescription plan.
The investigation by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor determined that while Schwartz never picked up or paid for the prescriptions, the pharmacies automatically submitted electronic claims to Horizon Blue Cross/Blue Shield for payment. Horizon Blue Cross/Blue Shield processed the electronic claims as though the prescriptions were valid and reimbursed Schwartz $19,569.
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