N.J.-Based Physician, Chiropractor Plead Guilty to $34,000 Fraud Scam to Pad Billings

New Jersey Division of Criminal Justice Director Vaughn McKoy announced that the operators of a Passaic County medical practice have pleaded guilty to submitting $34,000 in fraudulent billings to insurance companies in order to increase the amount of money paid for procedures which were not performed by the medical practice and not provided to patients.

According to Insurance Fraud Prosecutor Greta Gooden Brown, Alphonso Smith, 66, of Gloucester County, and Daniel Catanzaro, 44, Cartersville, Georgia, pled guilty before Passaic County Superior Court Judge Garry Rothstadt to Health Care Claims Fraud on May 3. Smith and Catanzaro are scheduled to appear before Judge Rothstadt on Aug. 6 to be sentenced

Gooden Brown noted that Smith and Catanzaro were charged via a State Grand Jury indictment returned on Dec. 17, 2003. Both Smith and Catanzaro were charged pursuant to the State’s Health Care Claims Fraud statute. The indictment alleged that

Smith, a licensed medical doctor, and Catanzaro, a licensed chiropractor, operated the Quality Care Physicians (d/b/a Physicians Plus) medical practice in Wayne, Passaic County. The investigation determined that Smith began the medical practice and was the medical director and sole shareholder, while Catanzaro ran the facility on a day-to-day basis.

At the guilty plea hearing, Smith and Catanzaro reportedly admitted that from July, 1997 through March, 1999, they submitted more than $34,000 in fraudulent and/or inflated bills to insurance companies seeking reimbursement for more expensive injected anesthesia (paravertebral nerve block injections) when, in fact, the services administered to patients were less expensive non-invasive electrical stimulation therapy. Smith and Catanzaro submitted the fraudulent health and automobile insurance claims to the Oxford Health Care Insurance Company, New Jersey Manufacturers Insurance Company, United Health Care, and Allstate Insurance Company.

The investigation and audit conducted by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor determined that Smith and Catanzaro submitted at least 92 fraudulent billings seeking more than $34,000 in insurance reimbursements.

Both Smith and Catanzaro have been suspended from the practice of medicine in New Jersey by the Board of Medical Examiners.