N.J. Man Charged with Falsifying Medical Records

New Jersey Division of Criminal Justice Director Vaughn McKoy announced that the Division of Criminal Justice – Office of Insurance Fraud Prosecutor has charged an Essex County man with insurance fraud for falsifying medical records in order to obtain more than $1,000 in Personal Injury Protection (PIP) payments.

According to Insurance Fraud Prosecutor Greta Gooden Brown, Reginald Smithson, 43, of Orange, Essex County, was charged via an Essex County Grand Jury indictment with theft by deception, insurance fraud (3rd degree), and two counts of forgery (4th degree). If convicted on all charges, Smithson faces up to 13 years in state prison and a fine of up to $40,000.

In addition, Smithson faces possible civil insurance fraud fines pursuant to the Insurance Fraud Prevention Act. Smithson will be ordered to appear in Essex County Superior Court for arraignment and bail.

The Essex County indictment charged that Smithson submitted a false claim to the State Farm Insurance Company for out-of-pocket expenses purportedly incurred in a Feb. 19, 2003 automobile accident. It is charged that five days after the accident, Smithson sought medical attention at Mountainside Hospital in Montclair, Essex County, and failed to mention the car accident. Since Smithson did not have health care insurance, the hospital did not charge for the visit.

An investigation by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor determined that in August 2003, after obtaining a property damage estimate for the car, Smithson allegedly returned to Mountainside Hospital in an attempt to obtain a blank receipt so he could submit a claim to State Farm Insurance for out-of-pocket expenses incurred as a result of the accident. When the hospital refused to provide a blank receipt, Smithson paid $1.00 toward the balance of his account and was given a receipt which reflected the $1.00 payment.

The investigation revealed that Smithson falsified the hospital receipt so that it purported to be in the amount of $1,001 and submitted it to State Farm Insurance Company in order to obtain money to repair his vehicle. Smithson also allegedly submitted a fraudulent $550 receipt to State Farm, falsely claiming that it was for a rental car.