N.J. Man Charged with $300,000 Fraud and Theft

New Jersey Attorney General Peter Harvey announced that a Hudson County businessman has been charged by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor with stealing more than $300,000 in health insurance claims money by reportedly misrepresenting that his company was a licensed supplier of prescription medicines and by billing for prescription medicine supply services that were never provided.

According to Vaughn McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden Brown, James Clark, 47, of Union City, was charged in a State Grand Jury indictment with two counts of theft by deception and one count of Health Care Claims Fraud. If convicted on all second degree charges, Clark faces up to 30 years in state prison and a fine of up to $450,00.

Insurance Fraud Prosecutor Brown noted that Clark is the president of Home Health Care Center, Inc., located in Hoboken as well as the Director of the now defunct Medical Care Management, Inc., d/b/a Mile Square Medical Group, formerly located in Weehawken. Home Health Care Center is a business that delivers prescription medications from pharmacies to person’s homes. Home Health Care is reportedly not licensed to dispense or otherwise sell prescription medications.

The indictment alleges that between Dec. 1, 1996 and Sept. 11, 1998, Clark, who is neither a medical service provider nor a licensed pharmacist, misrepresented to Horizon Blue Cross/Blue Shield that Home Health Care was licensed to supply, dispense, and sell prescription medications which were delivered to patients of Mile Square Medical Group and was therefore entitled to payment or reimbursement from the State Health Benefits Plans for the cost of the medications.

The indictment charges that Clark submitted as many as approximately 400 fraudulent insurance claims for various medications, approximately 330 of which may have been for medications that were never dispensed and never delivered to the patients. The total amount of fraudulent billings submitted by Clark to Horizon Blue Cross/Blue Shield and/or the State Health Benefits Program was reportedly in excess of $365,000, of which Horizon paid more than $343,000.

It is also alleged that many prescriptions HHC sold were grossly inflated over and above the customary price in the billings to the State Health Benefits Program.

The indictment was handed up to Mercer County Superior Court Judge Linda Feinberg, the Assignment Judge in charge of the State Grand Jury, on July 16. The case will be assigned for trial in Essex County Superior Court. Clark will be ordered to appear for arraignment and bail.