November 30, 10

NEWS / Medical Director of Defunct Mercer County Mental Health Clinic Sentenced for Defrauding the Medicaid

TRENTON - Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced that the medical director of a defunct Mercer County mental health clinic was sentenced today to state prison for his role in a conspiracy to fraudulently over-bill the Medicaid and Medicare programs close to $50,000.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Arnold Jacques, 61, of Jackson, the former medical director of the now-defunct Chambers Mental Health Clinic LLC, a mental health counseling center in Trenton, was sentenced to three years in state prison and ordered to pay a total of $49,941 restitution to the Medicaid and Medicare programs by Superior Court Judge Edward M. Neafsey in Mercer County. Jacques’ sentence was based on his Sept. 8 guilty plea to second-degree conspiracy, second-degree health care claims fraud, and third-degree Medicaid fraud. The charges were contained in a state grand jury indictment returned on Nov. 13, 2007.

In pleading guilty, Jacques, a medical doctor who practices as a psychiatrist, admitted that between January 2004 and November 2005, he conspired with the two co-owners of Chambers Mental Health Clinic to fraudulently over-bill the Medicaid and Medicare programs.

Jacques and his co-defendants, Pedro Acosta, 65, of Queens, N.Y., and Osvaldo Morales Sr., 62, of Bronx, N.Y., caused Medicaid and Medicare claims to be billed under Jacques’ Medicaid and Medicare provider numbers even though he did not personally provide the counseling services billed. In addition, among other things, the defendants billed Medicaid and Medicare for longer counseling sessions than those that were actually provided, billed for family counseling in addition to individual sessions for the same patient in the same day, and billed for counseling services that were not rendered at all. Medicaid pays a higher rate for longer counseling sessions and for counseling services provided by a specialist medical doctor as opposed to counselors with lesser licenses. The defendants thereby fraudulently billed the Medicaid and Medicare programs for close to $50,000 to which they were not entitled.

Acosta and Morales previously pleaded guilty for their roles in the scheme. Acosta pleaded guilty to second-degree health care claims fraud and Morales pleaded guilty to third-degree Medicaid fraud. Both defendants are awaiting sentencing.

Detectives Joseph Jaruszewski and Kevin Gannon and former Deputy Attorney General Sherry L. Wilson were assigned to the investigation. Deputy Attorney General Erik Daab represented the Office of the Insurance Fraud Prosecutor at the sentencing.

http://www.nj.gov/oag/newsreleases10/pr20101129a.html