Top Corporate Officer in N.J. Medicaid Clinic Sentenced to Prison for Insurance Fraud

New Jersey Attorney General Peter Harvey announced that the executive director of a Camden County outpatient mental health clinic has been sentenced to three years in state prison for submitting more than $13,000 in inflated patient billings to the Medicaid Program for payment and/or reimbursement. 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 such services and medicines.

According to Vaughn McKoy, director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden-Brown, Cristino Morales, 60, of Philadelphia, was sentenced by Camden County Superior Court Judge Irvin Snyder to three years in state prison, ordered to pay $10,000 in restitution to the Medicaid Program, and banned from participating in the Medicaid Program for a period of five years.

Gooden Brown noted that Morales, the former executive director of New Hopes of New Jersey, Inc., an outpatient mental health clinic located at 328 Market Street, Camden, was charged with Health Care Claims Fraud via a State Grand Jury indictment returned on March 13, 2003. The indictment also charged Maria Carmen Cruz, 39, Philadelphia, with Health Care Claims fraud and Medicaid fraud. Additionally, Patrick Traynor, 63, of Abington, Pa., was charged with Medicaid Fraud via a separate criminal Accusation. Traynor was employed as the program director for New Hopes, while Cruz served as the clinic administrator.

In pleading guilty on Oct. 27, 2003 before Judge Snyder, Morales reportedly admitted that from May – October, 1999, more than $13,000 in fraudulent invoices were submitted to the Medicaid Program. The phony invoices sought payment for mental health counseling and psychological services which were never provided. Specifically, Morales submitted bills for individual mental health counseling services when such counseling sessions were not provided. (Medicaid regulations prohibit billing for multiple family members.) Morales also admitted submitting fraudulent billings for mental health counseling sessions purportedly provided to children when no such sessions ever took place.

Traynor pleaded guilty to Medicaid Fraud charges on Feb. 11, 2003, reportedly admitting that from March – June, 1999, he prepared, at Morales’ direction, patient progress notes for counseling sessions which never occurred. As a result of Traynor’s actions, New Hopes submitted fraudulent billings to the Medicaid Program for payment for counseling sessions that did not occur. On Dec. 5, Traynor was sentenced to three years probation conditioned on performing 150 hours of community service. Traynor was also debarred from participating in the Medicaid Program for a period of five years.

Cruz pleaded guilty to the charges on Sept. 15, and was sentenced to three years probation conditioned upon performing 150 hours of community service on Dec. 5. Cruz was also barred from participating in the Medicaid Program for five years.