Cream Ridge Doctor Indicted for Allegedly Seeking Payment for 40 Medical Diagnostic Procedures He Never Conducted
Yesterday, New Jersey Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor announced a 43-count indictment from the state grand jury that charges a Cream Ridge doctor for allegedly submitting claims to insurance carriers for nerve conduction studies he never actually performed.
In the indictment against Hector Lopez, 38, Acting Insurance Fraud Prosecutor Ronald Chillemi is alleging that Lopez sought payment of $152,350 from the carriers for approximately 40 studies, conducted on 38 patients from September 2009 through April 2010. It is alleged that Lopez received between $53,811 and $58,117 from the insurance carriers for phantom procedures. Nerve conduction studies are used as a medical diagnostic tool to evaluate the function and ability of the human body’s nerves.
Lopez has been charged with 40 counts of second-degree health care claims fraud, and one count each for second-degree attempted theft by deception, third-degree theft by deception and fourth-degree falsifying records.
“Doctors are trusted and held in the highest esteem in our society, thus I find this defendant’s alleged fraud particularly disturbing,” said Acting Attorney General Hoffman. “Lopez allegedly perpetrated a seven-month fraud spree that made it look like he was caring for patients, when in reality he was enriching himself with undeserved insurance payments.”
The indictment alleges that Lopez conducted the procedures at Performance Spine and Sports Medicine in Lawrence, a clinic of which Lopez was a founding partner. Lopez’s colleagues at the clinic discovered his scam, forced him out of the medical partnership and also required him to repay what he had allegedly stolen. They later reported his unscrupulous behavior to the New Jersey State Board of Medical Examiners. That board suspended his medical license for three years, beginning on June 14, 2011. Lopez’s license remains suspended.
“The defendant was ensnared by his partners, has had to surrender his license, and is now facing significant time in prison for his alleged misdeeds,” said Acting Insurance Fraud Prosecutor Ronald Chillemi. “He has been rebuked by those in his profession, and will now have to answer to a jury of his peers.”
Deputy Attorney General T.J. Harker and Detectives Wendy Berg, Grace Rocca and Matt Armstrong coordinated the investigation. Analyst Kelly Celenza provided substantial assistance in the financial analysis of the investigation.
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, while third-degree crimes carry a maximum sentence of five years in state prison and a criminal fine of up to $15,000. Fourth-degree crimes carry a maximum sentence of 18 months in state prison and a criminal fine of up to $10,000.
Acting Insurance Fraud Prosecutor Chillemi noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll‑free hotline at 1‑877‑55‑FRAUD, or visiting the Web site at www.NJInsurancefraud.org. State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.