August 25, 10

NEWS / Middlesex County Dentist Pleads Guilty to Defrauding Medicaid by Billing for Procedures Not Performe

TRENTON - Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor, announced that a Middlesex County dentist pleaded guilty today to defrauding the Medicaid program of almost $85,000.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Larry Berman, 56, of Edison, a licensed dentist employed by New Jersey Mobile Dentist P.A. of Colts Neck, pleaded guilty to an accusation charging him with third-degree conspiracy to commit Medicaid fraud before Superior Court Judge Francis J. Vernoia in Monmouth County. The accusation was filed by the Office of the Insurance Fraud Prosecutor=s Medicaid Fraud Control Unit, which investigates and prosecutes both civil and criminal Medicaid fraud related cases.

Berman admitted that between January 1, 2006, and March 10, 2009, as a Medicaid provider, he willfully received medical assistance payments to which he was not entitled. The payments related to fraudulent bills submitted to Medicaid for dental services for beneficiaries at various nursing homes and assisted living facilities that he did not provide or that were not medically necessary. The investigation revealed that as a result of the alleged fraudulent billing, Medicaid paid New Jersey Mobile Dentist, which had used Dr. Berman=s Medicaid provider number, over $280,000 to which it was not entitled. New Jersey Mobile Dentist contracts with individual dentists to provide Amobile@ dental services in such facilities throughout New Jersey.

Under the plea agreement, the state will recommend that Berman be sentenced to up to 364 days in county jail as a condition of a term of probation. Berman must pay the state a total of $169,164, including $84,582 in restitution for amounts he received from New Jersey Mobile Dentist in connection with the fraudulent billing and an equal civil penalty of $84,582. Those payments will be made through the Office of the State Comptroller, Medicaid Fraud Division, which commenced operations in 2009 to investigate fraud, waste and abuse in the Medicaid program.

Deputy Attorney General Debra A. Conrad represented the Office of Insurance Fraud Prosecutor at the guilty plea hearing. Sgt. Kathleen Casey, Auditor Kim Geis and Deputy Attorney General Conrad are assigned to the ongoing investigation.

Judge Vernoia scheduled sentencing for Berman for Dec. 10. This matter will be referred to the Division of Consumer Affairs, which may result in legal action against his professional license.

Five other dentists associated with New Jersey Mobile Dentist have previously pleaded guilty in this investigation:

* Joshua Prensky of Fair Lawn;
* Christopher Lillo of Toms River;
* Anna Pavda-German of Secaucus;
* Marc Wertheim of Moonachie; and
* Subina Anand of Plainsboro.

AThese dentists exploited a vulnerable population, namely elderly and disabled patients. Medical professionals are given a tremendous amount of trust, and we will continue to aggressively prosecute those who take advantage of that trust,@ said Acting Insurance Fraud Prosecutor Dagli.

On Aug. 25, 2009, Wertheim, 45, pleaded guilty to third-degree Medicaid fraud. He admitted that between January 1, 2003, and March 10, 2009, as a Medicaid provider, he willfully received medical assistance payments to which he was not entitled. The investigation revealed that as a result of the allegedly fraudulent billing, Medicaid paid New Jersey Mobile Dentist, which had used Dr. Wertheim=s Medicaid provider number, over $280,000 to which it was not entitled. Wertheim is awaiting sentencing. Under the plea agreement, the state will recommend that he be sentenced to 364 days in county jail as a condition of a term of probation. He must pay $225,715 to the state, representing the share of the fraudulent Medicaid billings he received from New Jersey Mobile Dentist plus a civil penalty.

On Jan. 19, 2010, Anand pleaded guilty to third-degree Medicaid fraud. She admitted that between January 1, 2003, and March 10, 2009, as a Medicaid provider, she willfully received medical assistance payments to which she was not entitled. The investigation revealed that as a result of the allegedly fraudulent billing, Medicaid paid New Jersey Mobile Dentist, which had used Dr. Anand=s Medicaid provider number, over $850,000 to which it was not entitled. Anand is awaiting sentencing. Under the plea agreement, the state will also recommend that she be sentenced to 364 days in county jail as a condition of a term of probation. She must pay $415,201 to the state, representing the share of the fraudulent Medicaid billings she received from New Jersey Mobile Dentist plus a civil penalty.

The Medicaid program, which is funded by the state and federal governments, provides health care services and prescription drugs to persons who may not otherwise be able to afford them. The State of New Jersey administers the Medicaid Program through the Division of Medical Assistance and Health Services and through the Office of the Insurance Fraud Prosecutor=s Medicaid Fraud Control Unit.

http://www.nj.gov/oag/newsreleases10/pr20100824a.html