Vaughn McKoy, director, Division of Criminal Justice, announced that an Essex County, New Jersey man has pleaded guilty for his role in a $1.2 million conspiracy to commit Health Care Claims Fraud and theft by deception as part of a broad-based chiropractic and automobile insurance fraud scheme.
According to Insurance Fraud Prosecutor Greta Gooden-Brown, Carl Love, Jr., 47, of West Orange, Essex County, pleaded guilty before Essex County Superior Court Judge Paul Vichness to third degree conspiracy and fourth degree possession of a weapon by a convicted felon.
A third degree crime carries a sentence of up to five years in state prison and a fine of up to $15,000, while a fourth degree crime is punishable by up to 18 months in state prison and a fine of up to $10,000. Love may also face civil insurance fraud fines pursuant to the civil Insurance Fraud Prevention Act. Love is scheduled to appear before Judge Vichness on April 25 for sentencing.
Gooden-Brown noted that Love, along with four other defendants, was charged via a State Grand Jury indictment returned on Nov. 17, 2003. The indictment alleged that the defendants devised an insurance fraud scam geared to steer patients to a chiropractic business operated by Dr. Lisa Tsilionis, 42, and her former husband, Dr. George Tsilionis, 44, formerly of Bergenfield, Bergen County. The indictment charged the Tsilionis’ with conspiracy, Health Care Claims Fraud, theft by deception, financial facilitation of criminal activity (money laundering), and misconduct by a corporate official. Also charged was Rudolph Hora, 37, of Newark, and/or East Orange. Hora was charged with aiding in the conspiracy.
The indictment alleged that between Feb. 9, 1996 and March 31, 1999, Love, the president and owner/operator of two corporations doing business as the Love Courier, Inc. and Essex Shuttle Inc., used the transportation company’s to funnel patients to the Tsilionis’ chiropractic office (Allied Trauma) located in East Orange.
In so doing, it is alleged that the Tsilionis’ increased the number of patients and the amount of PIP claims submitted to insurance companies for payment of various medical, diagnostic, and chiropractic treatments. Based in part on Love’s assistance in directing patients to Allied Trauma, it is charged that the Tsilionis’ fraudulently billed 30 different insurance companies more than $1.2 million in PIP claims. The claims sought payment for chiropractic services and electric diagnostic tests known as Somatosensory Evoked Potentials (SSEP) – chiropractic procedures that are frequently used to diagnose injuries in connection with automobile accidents. It is alleged that the insurance companies paid more than $435,000 on the claims submitted by the Tsilionis’ and Allied Trauma.
In pleading guilty, Love reportedly admitted that he was paid by Dr. George Tsilionis and Dr. Lisa Tsilionis to direct patients to Allied Trauma for treatment so that the false PIP claims could be submitted to the various automobile insurance companies — in essence, Love admitted being a runner for Allied Trauma. Love’s corporations ceased operation following the execution of search warrants by investigators assigned to the Office of the Insurance Fraud Prosecutor.
Additionally, Love’s corporate bank accounts were frozen and forfeited to the State. A lien was also filed on Love’s West Orang home. Love subsequently filed for bankruptcy.
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