N.J. Dentist Drilled in Medicaid Scam

New Jersey Division of Criminal Justice Director Vaughn McKoy announced that a Somerset County dentist has been sentenced to three years in state prison for his reported role in spearheading a Medicaid and insurance fraud scam that netted more than $95,000 in fraudulent payments for dental services never provided to patients.

According to Insurance Fraud Prosecutor Greta Gooden Brown, Dr. Roger H. Brown, 49, of Warren, Warren County, was sentenced by Somerset County Superior Court Judge Paul Armstrong to three years in state prison and ordered to pay a $25,000 criminal penalty. Brown previously paid $310,546 in restitution and civil fines to the Medicaid Program and private insurance companies.

Gooden Brown said that Dr. Brown, a licensed dentist and the owner of Amwell Dental Associates located at 601 Route 206, Hillsborough, Somerset County, pleaded guilty before Judge Armstrong on May 27 to a criminal Accusation that charged Health Care Claims Fraud.

In pleading guilty, Brown reportedly admitted that between January, 1993 and September, 2004, to submitting hundreds of false claims for reimbursement of dental services purportedly provided to patients to various medical providers, including the Medicaid Program, Delta Dental, MetLife, Horizon Blue Cross/Blue Shield, CIGNA Insurance, and Aetna Insurance companies.

The investigation revealed that $95,182 in false claims were submitted to the medical service providers – $59,970 in false claims sent to the Medicaid Program and $35,213 billed to private insurance companies. The false claims represented bills for dental services that were not provided to patients.

In other cases, Brown admitted that he misrepresented the dates on which services were rendered and fraudulently billed for providing Temporomandibular Joint Dysfunction (TMJ) Nightguards when providing cosmetic dental services not covered by private dental insurance.