N.J. Dentist Charged with $86,000 in Insurance Fraud

New Jersey Attorney General Peter Harvey announced that a Trenton dentist has been charged by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor with Health Care Claims Fraud and theft for billing insurance companies nearly $86,000 for dental services reportedly never provided to patients.

According to Vaughn McKoy, director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden Brown, Dr. Paul Anodide, 47, of Mercer County, was charged via a State Grand Jury indictment with theft by deception and Health Care Claims Fraud. Anodide faces up to 20 years in state prison and a fine of up to $300,000 if convicted on both second degree charges. Additionally, Anodide faces possible civil insurance fraud fines pursuant to the Insurance Fraud Prevention Act.

Gooden Brown noted that the State Grand Jury indictment alleges that between October, 1993 and December, 2002, Anodide submitted more than 75 fraudulent dental insurance claims totaling $85,914 to three insurance companies seeking reimbursement and payment for dental services that were never provided. The fraudulent claims, purportedly for dental services provided to 28 individual patients, included procedures such as root canal, crowns, and fillings.

In some instances, the fraudulent billings sought payment for dental procedures which were performed twice on the same tooth. The indictment also charges that Anodide billed for dental services that were provided on Sundays when the dental office was closed.

The Office of Insurance Fraud Prosecutor’s investigation determined that Anodide submitted fraudulent claims to Prudential Health Care of New Jersey, Aetna/US. Healthcare, and Delta Dental Insurance Company. For a portion of the time alleged in the indictment, Prudential was the third party claims administrator for the New Jersey State Health Dental Plan which provides dental services to state employees. While Prudential processed dental insurance claims for the State of New Jersey, the claims were paid with state monies. Approximately $62,846 was paid to Anodide by the various insurance carriers

The indictment was handed up to Mercer County Superior Court Judge Maria Marinari Sypek on Jan. 22. The case will be assigned to the Mercer County Superior Court for trial. A complaint summons will be issued to Anodide requiring him to appear in Court for arraignment and bail.