April 28, 10

NEWS / North Jersey Chiropractor Charged With Fraudulent Insurance Billings

TRENTON Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced that a North Jersey chiropractor has been indicted for allegedly billing an insurance company for chiropractic treatments that were never rendered.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Michael P. Gold, 59, of Chester, a licensed chiropractor, was charged yesterday (April 27) with 16 counts of second-degree health care claims fraud and four counts of fourth-degree falsifying records.

The state grand jury indictment alleges that on 16 occasions between Aug. 13 and Dec. 2, 2008, Gold fraudulently submitted claim forms to the Allstate Insurance Company for chiropractic treatments purportedly performed on a patient, when, in fact, he had not provided the services. The “patient” was actually an undercover investigator with the Division of Criminal Justice. The indictment further alleges that on four occasions, Gold falsified medical records of office visits when he knew that the office visits did not occur.

Detective Ned Shaw, Civil Investigator Chris Gasbarro, and Assistant Attorney General John Kennedy were assigned to the investigation. Assistant Attorney General Kennedy presented the case to the state grand jury. Acting Insurance Fraud Prosecutor Dagli thanked the Allstate Insurance Company for their assistance with this investigation.

The indictment is merely an accusation. The defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of $150,000, while fourth-degree crimes carry a maximum sentence of 18 months in state prison and a criminal fine of $10,000. Gold may also face the imposition of civil insurance fraud fines. This matter will be referred to the state Board of Chiropractic Examiners for any licensing action they deem appropriate.

http://www.nj.gov/oag/newsreleases10/pr20100428b.html