July 15, 10

NEWS / North Jersey Physician Charged with Medicaid Fraud and Illegally Dispensing Controlled Drugs

TRENTON - Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced that a North Jersey neurologist was charged in a state grand jury indictment today for his alleged role in a pharmaceutical narcotics trafficking and Medicaid fraud scam.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Dr. Magdy Elamir, 57, of Saddle River, was charged with second-degree conspiracy, second-degree distribution of a controlled dangerous substance (CDS) and two counts each of second-degree health care claims fraud and second-degree distribution of CDS within 500 feet of certain public property, as well as three counts of third-degree Medicaid fraud, two counts of third-degree distribution of CDS within 1,000 feet of school zone, and one count of third-degree distribution of CDS.

Deputy Attorney Debra A. Conrad presented the case to the state grand jury.

The state grand jury indictment alleges that between Jan. 1, 2007 and Oct. 20, 2009, Elamir, a neurologist who has a practice in Jersey City, conspired with others to submit fraudulent claims to the Medicaid program for reimbursement and received payments for medical examinations that had not been provided. It is also alleged that Elamir conspired to write medically unnecessary prescriptions for Medicaid beneficiaries, thereby causing pharmacies to submit claims to Medicaid for the medically unnecessary drugs.

The indictment further alleges that Elamir distributed CDS by providing medically unnecessary prescriptions for Xanex and Percocet in exchange for cash payments within 500 feet of the Jersey City Public Library, a public building, and within 1,000 feet of St. Joseph’s School which is owned or leased by the Archdiocese of Jersey City.

Today’s indictment stemmed from Operation MedScam, an ongoing investigation by the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit and the Jersey City Police Department’s Special Investigation Unit. Since October, more than 32 people, including doctors and pharmacists, have been arrested in the joint investigation, which uncovered a criminal narcotics network based in Hudson County that distributed black market prescription pain pills

such as OxyContin and Percocet. The network was obtaining fraudulent narcotics prescriptions and filling them at various pharmacies. At the same time, Medicaid was being billed for phony doctor visits and prescription medicines that were never dispensed.

The network allegedly distributed the prescription pain pills throughout Hudson County and other parts of the state, including Bergen, Ocean, Morris and Monmouth counties. A single 30 milligram OxyContin pill, known as a “blue,” typically sells for $10 to $20 on the street, while a 10 milligram Percocet pill sells for $5 to $8.

Detective Kevin Gannon, Sgt. Frederick Weidman and Deputy Attorneys General Erik Daab, who is the Chief of the Medicaid Fraud Control Unit, Cynthia Vazquez and Conrad were assigned to the investigation.

They were assisted by Medicaid Fraud Control Unit Analyst Mitzi Gross and Anne Howell, RN., as well as the following members of the Jersey City Police Department’s Special Investigation Unit under the supervision of Chief Thomas Comey: Capt. Gary Lallo, Sgt. Anthony Musante, Sgt. Wally Wolf, Detective Wael Shahid, Detective Jeff Guilfoyle, Detective Vincent Disbrow, Detective Hector Marrero, Police Officer Alex Torres, Police Officer Chris Dolan, and Police Officer Erik Infantes.

“As this indictment demonstrates, we are moving forward expeditiously to bring the members of this criminal network to justice for distributing dangerous narcotics in our communities,” said Acting Insurance Fraud Prosecutor Dagli. “We have also charged other doctors and pharmacists with participating in this ring and falsely billing Medicaid.”

The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of up to $150,000. Third-degree crimes carry a maximum sentence of five years in state prison and a criminal fine of up to $15,000, while the crime of third degree Medicaid Fraud carries a maximum sentence of three years in state prison and a criminal fine of up to $10,000.

http://www.nj.gov/oag/newsreleases10/pr20100715b.html