N.J. Doc, Niece Keep Insurance Fraud a Family Matter

Vaughn McKoy, New Jersey director, Division of Criminal Justice, announced that an Essex County doctor and his niece have been ordered to pay more than $30,000 in restitution and fines after pleading guilty to multiple counts of insurance fraud, including submitting fraudulent insurance claims for medical services that were never provided to patients.

According to Insurance Fraud Prosecutor Greta Gooden-Brown, Dr. LeClerc Adisson, 58, of Irvington, Essex County, and his niece, Lunic Adisson, 34, same address, were sentenced by Essex County Superior Court Judge Paul Vichness on April 19.

Judge Vichness sentenced Dr. LeClerc Adisson to serve 364 days in the Essex County Jail as a condition of five years probation. Additionally, Dr. Adisson was ordered to pay $26,000 in restitution to nine New Jersey insurance companies, a $5,000 civil insurance fraud fine, and to surrender his medical license. Lunic Adisson was ordered to pay a $2,500 civil insurance fraud fine and to perform 50 hours of community service.

In pleading guilty on March 4 to a charge of theft by deception, Dr. Adisson, the former owner of Laguardia Primary Health Care, 108 South Munn Ave., East Orange, Dantor Medical Supply Co., and Clara Medical Services, and Lunic Adisson (niece) reportedly admitted that from April, 1997 through December, 2000, they improperly treated and referred patients to the various Adisson-owned facilities.

As a result of those actions, Adisson reportedly inflated claims for services and medical supplies that were not prescribed by treating chiropractic physicians and then sought payment for services and supplies that were not provided to patients.

The investigation determined that $48,273 in fraudulent bills were submitted to the Zurich Insurance Group, Century Insurance Company, New Jersey Manufacturers Insurance Company, Progressive Insurance Company, MDA Insurance Company, Liberty Mutual Insurance Company, Keystone Insurance Company, Prudential Insurance Company, Clarendon Insurance Company, and State Farm Insurance Company.

Gooden-Brown noted that Dr. Adisson also pleaded guilty to a separate criminal Accusation which charged Health Care Claims Fraud and the criminal use of “runners”. The Accusation charged that from February, 2000 through September, 2001, Dr. Adisson and another chiropractor (not named as a defendant) submitted false auto insurance Personal Injury Protection (PIP) claims to Parkway Insurance.

Adisson reportedly admitted that he employed a “runner” to procure additional patients in order to beef-up the submission of insurance claims. In using a “runner” and in recklessly using the other chiropractor’s false treatment notes, Adisson was able to increase the amount of claims submitted to insurance companies.

Additionally, Adisson admitted that referrals for MRI services came from an outside medical chiropractor and that he paid a “runner” $100 for each MRI scan and $300 for every patient referred to his practice by the outside chiropractor for treatment. Parkway Insurance Company was billed $19,494 for treatments never provided to patients.

Gooden-Brown said that Lunic Adisson also pleaded guilty to an unrelated charge of simulating a motor vehicle insurance identification card contained in a June 27, 2003 Essex County Grand Jury indictment.

The indictment charged that Adisson produced and supplied a motor vehicle insurance identification card to an Irvington, Essex County, police officer in order to regain possession of her impounded vehicle. The charge arose from a separate investigation conducted by the Office of the Insurance Fraud Prosecutor.