More than 400 False Health Claims Lands N.J. Man Behind Bars for 9 Years

April 6, 2005

New Jersey Attorney General Peter Harvey announced that a Hudson County businessman has been sentenced to nine years in State Prison for submitting more than 400 fraudulent health insurance claims totaling more than $300,000 in illegal payments.

According to Vaughn McKoy, director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden-Brown, James Clark, 49, of Union City, Hudson County, was sentenced by Essex County Superior Court Judge Michael Petrolle to nine years in State Prison and ordered to pay a $5,000 fine. Clark was sentenced on April 1 after being found guilty on charges of theft by deception and Health Care Claims Fraud after a Feb. 10 jury trial.

Gooden-Brown said that the Essex County jury found that between Dec. 1, 1996 and Sept. 11, 1998, Clark, as president of Home Health Care Center Inc., located on First Street, Hoboken, Hudson County, misrepresented to Horizon Blue Cross/Blue Shield (which administers health care claims for the State Health Benefits Program) that Home Health Care was licensed to supply, dispense, and sell prescription medications which were delivered to patients and was entitled to payment or reimbursement from the State Health Benefits Plans for the cost of the medications.

Home Health Care Center was in business to deliver prescription medications from pharmacies to person’s homes and was not licensed to dispense or otherwise sell prescription medications. Clark was reportedly neither a medical service provider nor a licensed pharmacist.

An investigation by the Office of Insurance Fraud Prosecutor reportedly determined that Clark submitted more than 400 fraudulent insurance claims for various medications — approximately 330 of which may have been for medications that were never dispensed and never delivered to patients.

The total amount of the fraudulent billings submitted by Clark to the State Health Benefits Program was in excess of $365,000, of which more than $343,000 was paid.

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