Former N.J. CPA Pleads Guilty in Health Care Scam

New Jersey Division of Criminal Justice Director Vaughn McKoy announced that a former Bergen County certified public accountant has agreed to pay $325,000 in restitution after pleading guilty to Health Care Claims Fraud for inflating and submitting fraudulent insurance claims for medical services that were never provided to patients.

According to McKoy and Insurance Fraud Prosecutor Greta Gooden-Brown, Barry Cohen, 51, of Parkland, Fla., pleaded guilty before Bergen County Superior Court Judge Joseph Conte to Health Care Claims Fraud (2nd degree). The charge was contained in a State Grand Jury indictment filed by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor on Sept. 8, 2004. When sentenced on May 13, Cohen faces up to 10 years in state prison and a fine of up to $150,000.

Gooden-Brown noted that Cohen operated a family-owned corporation known as Headways Inc., formerly located in Bergen County. Headways, which ceased operations in November, 2000, provided health care services and therapy to patients suffering from brain injuries.

At the March 7 guilty plea hearing, Cohen reportedly admitted that between Jan. 15, 1998 and April 30, 2001, he knowingly submitted dozens of health care claims to insurance companies and/or self-funded health benefit plans for patient therapy and related treatments by adding additional hours and/or dates of therapy which were never provided.

An investigation by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor determined that Cohen added more than 4,000 additional hours of services totaling more than $350,000 to dozens of bills submitted to the insurance companies for reimbursement or payment.

The insurance companies and health benefits plans that received the false claims included Allstate Insurance Company, Horizon Blue Cross/Blue Shield of New Jersey, State Farm Insurance Company, Proformance Mutual Insurance Company, and Key Benefit Administrators, a third party claims administration company which administered health insurance for the Teamsters Union Local 560 Benefit Fund, as well as the New Jersey Automobile Full Insurance Underwriting Association.