FOR IMMEDIATE RELEASE
December 8, 2011
Doctor submitted fraudulent claims for 900 procedures
NEWARK, N.J. – A North Caldwell, N.J., doctor today admitted his role in defrauding Blue Cross Blue Shield of more than $725,000 by submitting false claims for services he never performed, U.S. Attorney Paul J. Fishman announced.
Dr. Michael P. Stein, 62, pleaded guilty before U.S. District Judge Esther Salas in Newark federal court to an Information charging him with one count of knowingly and willfully executing a scheme and artifice to defraud Blue Cross Blue Shield by filing false claims for services that were not rendered and office visits that did not occur.
According to documents filed in this case and statements made in court:
Between August 2004 and September 2010 Stein was the owner and operator of Randolph Otolaryngology P.C., a medical treatment facility. During that time, Stein treated a patient with the initials J.F. for nasal problems and billed Blue Cross Blue Shield for the services he purportedly performed.
Stein admitted he filed fraudulent claims with Blue Cross Blue Shield for medical procedures that were not performed during office visits. Stein submitted claims for approximately 900 nasal endoscopies he purportedly conducted on the patient, when in truth, only a few were actually performed. Stein also admitted he filed fraudulent claims for office visits and medical procedures that purportedly occurred while he was away on vacation. Between Sept. 6, 2010, and Sept. 27, 2010, Stein billed Blue Cross Blue Shield for 11 nasal endoscopies and 10 office outpatient visits for purported services rendered to J.F. In truth, J.F. ceased seeing Stein around Sept. 3, 2010, and Stein was in Germany from Sept. 11, 2010 through Sept. 27, 2010. Stein received $725,156.45 from Blue Cross Blue Shield as a result of his submission of the false claims, and, under the plea agreement, Stein agreed to pay restitution and forfeiture in the same amount.
The fraud charge to which Stein pleaded guilty carries a maximum potential prison sentence of 10 years and a fine of $250,000, or twice the gross gain or loss from the offense. Stein’s sentencing is currently scheduled for March 19, 2012.
U.S. Attorney Fishman credited special agents and investigators of the FBI, under the direction of Special Agent in Charge Michael B. Ward; Health and Human Services/OIG under the direction of Special Agent in Charge Thomas ODonnell; and the Railroad Retirement Board/OIG under the direction of Special Agent in Charge Michael Angelucci with the investigation leading to today’s guilty plea.
The government is represented by Assistant U.S. Attorney Jacques S. Pierre of the U.S. Attorney’s Office Health Care and Government Fraud Unit and Jacob T. Elberg, Deputy Chief of the U.S. Attorney’s Office Health Care and Government Fraud Unit.
Defense counsel: Daniel Giaquinto Esq., Bridgewater, N.J.