New Jersey Attorney General Peter Harvey announced that husband and wife chiropractors, along with three individuals acting as “runners,” have been charged by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor with reportedly masterminding an Essex County insurance fraud scheme which billed dozens of insurance companies more than $1 million for chiropractic and patient transportation services that were never provided.
According to Vaughn McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden Brown, a State Grand Jury indictment charges Litsa (Lisa) Tsilionis, 41, and her former husband, George Tsilionis, 42, of Bergen County, with second degree conspiracy, Health Care Claims Fraud, theft by deception, financial facilitation of criminal activity (money laundering), and misconduct by a corporate official.
The State Grand Jury indictment also charged Carl Love, Jr., 27, of West Orange; Rajauhn Sharrieff, 52, of Newark; and Rudolf Hora, of Newark and/or East Orange. Love and Sharrieff were charged with conspiracy, Health Care Claims Fraud, theft by deception and misconduct by a corporate official. A separate indictment charged Love with the unlawful possession of a .25 caliber handgun recovered during a search of his residence. Hora was charged with conspiracy.
A second degree crime carries a maximum penalty of up to 10 years in state prison and a fine of up to $150,000. A third degree crime is punishable by up to five years in state prison and a fine of up to $15,000. Additionally, the defendants face possible civil insurance fraud fines pursuant to the Insurance Fraud Prevention Act.
The Division of Criminal Justice – Office of Insurance Fraud Prosecutor’s investigation reportedly determined that Lisa and George Tsilionis were licensed chiropractors and were the owners, operators and corporate officers of Allied Trauma and Health Care Center, Inc. and Accutest Mobile Diagnostics Group — both corporations operated out of offices located at 55 Washington Street, East Orange, Essex County. Love and Sharrieff operated Essex Shuttle, Inc., a transportation company which also maintained its business address at Allied Trauma’s offices in East Orange. Essex Shuttle purportedly transported patients to and from medical appointments.
According to Gooden Brown, the indictment alleges that from July, 1996 through March, 1999, the Tsilionis’, in their capacities as licensed chiropractors and the owners/operators of Allied Trauma, fraudulently billed 30 different insurance carriers more than $1.2 million in Personal Injury Protection (PIP) claims. The claims sought payment for chiropractic services and electrodiagnostic tests known as Somatosensory Evoked Potentials (SSEP) – chiropractic procedures that are frequently used to diagnose injuries in connection with automobile insurance claims – that the were never provided to patients. The insurance carriers paid approximately $435,000 on the claims submitted by the Tsilionis’ and Allied Trauma.
As part of the alleged corruption scheme, the indictment charges that the Tsilionis’ falsified chiropractic treatment records to establish the clinical support necessary to justify SSEP testing; falsified SSEP records; and directed staff to submit bills for chiropractic treatments and other therapeutic treatments that were never provided to patients. An audit of Allied’s books and records determined that the number of treatments billed to insurance carriers far exceeded the number of treatments that could realistically be performed by Allied staff.
Additionally, it is alleged that in cases where patients were actually treated, records were altered to bill for additional services that were not provided.
The indictment also charged that from June through December, 1998, Love and Sharrieff created Essex Shuttle to make it appear that the Tsilionis’ were paying Essex Shuttle for transportation services, when, in fact, they allegedly were paying Love, Sharrieff and Hora to act as “runners” for Allied Trauma.
It is alleged that Love and Hora were paid to produce a steady stream of automobile accident insurance claimants for Allied Trauma so that inflated and fraudulent PIP claims could be submitted to insurance carriers. Additionally, it is alleged that Love and Sharrieff, through Essex Shuttle, fraudulently billed various insurance carriers more than $5,400 for transportation services that were never provided.
The indictments were handed up to Mercer County Superior Court Judge Maria Marinari Sypek on Nov. 17. The case has been assigned to the Essex County Superior Court for trial. The defendants will be ordered to appear in Court for arraignment and bail.
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