May 20, 10

NEWS / Attorney General Announces Settlement of Insurance Fraud Lawsuit Against North Jersey Pain Managemen

TRENTON – Attorney General Paula T. Dow announced today that an Essex County pain management center and its owner have agreed to pay $88,517 to resolve a State lawsuit that accused the defendants of performing chiropractic services on patients despite not being authorized to do so, then billing insurance companies for those services.

The State’s original lawsuit against the Newark Pain Management & Rehabilitation Center and its owner-president, Daniel Enemuo, of Lake Hopatcong, was filed in Superior Court by attorneys for the Division of Law on behalf of the New Jersey Office of the Insurance Fraud Prosecutor (OIFP) in April 2009.

According to Acting Insurance Fraud Prosecutor Riza Dagli, neither Newark Pain Management nor Enemuo were authorized to provide chiropractic services to patients, but did so anyway from approximately July 2003 through November 2004. New Jersey law prohibits corporations from providing chiropractic services to patients if the corporation is owned by unlicensed individuals.

Under terms of the settlement, both Newark Pain Management and Enemuo have admitted to causing false and/or misleading claims to be provided to insurance companies by failing to disclose that Newark Pain Management was unauthorized to provide chiropractic services. They also have admitted to violating the New Jersey Insurance Fraud Prevention Act.

The defendants’ settlement payment includes a $75,000 civil penalty, $7,347 in reimbursement of the State’s attorneys’ fees and $6,170 in restitution to State Farm Insurance.

“New Jersey’s regulatory requirements are an important component of ensuring patient safety and must be followed,” said Acting Insurance Fraud Prosecutor Dagli.

As part of the same OIFP lawsuit, the State previously settled with a third defendant, Dr. Delores Ensley of Newark. Ensley paid a $10,000 civil penalty in 2009 and admitted that she treated patients for three months at Newark Pain Management after her chiropractic license had expired, thereby causing claims to be submitted to insurance carriers. She also admitted violating the New Jersey Insurance Fraud Prevention Act.

Supervising Civil Investigator Craig Leshner was assigned to investigate the case. Deputy Attorney General Brian Brennan of the Division of Law’s Banking, Insurance and Insurance Fraud Section represented the State in the lawsuit.

The case was referred to the OIFP by State Farm Insurance. Acting Insurance Fraud Prosecutor Dagli thanked State Farm for its assistance in this matter.

http://www.nj.gov/oag/newsreleases10/pr20100520a.html

Tags: corporation,