AHA was referring to a report from Department of Health and Human Services’ (HHS’) Office of Inspector General (OIG) last month. OIG looked at a random sample of 250 prior authorization denials made by 15 major insurers back in 2019. It found that only 13% of the denials followed Medicare coverage requirements and so did only 18% … Read more
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Steven Monaco, 40, was accused of leading two related scams that defrauded public health insurance plans, according to the U.S. Attorney’s Office for New Jersey. In one scheme, the Sewell man arranged for kickbacks with a doctor, Daniel Oswari, that allowed Monaco to receive $36,000 in commissions as a sales representative for a medical diagnostic laboratory between late … Read more
NEWARK, N.J. — Sagy Grinberg, 39, of Weehawken, N.J., was arrested on Friday, April 1 and charged with the following: Health care claims fraud (2nd degree); Forgery (two counts, 3rd degree); Obtaining Xanax by fraud (3rd degree); Obtaining Oxycodone/Percocet by fraud (3rd degree); Obtaining D-Amphetamine by fraud (3rd degree); Obtaining Adderall by fraud (3rd degree); and … Read more
NEWARK, N.J. — A doctor convicted of health care fraud and conspiracy to commit health care fraud in connection with her filing of fraudulent claims to Medicare and private insurance companies is not entitled to a new trial based on testimony submitted by government prosecutors at trial because the conduct alleged in the testimony was … Read more
CAMDEN, N.J. — In a one-page order, a federal judge in New Jersey on Dec. 20 issued a judgment in favor of an insurer in a homeowners insurance dispute stemming from the insurer’s denial of its insureds’ claim for fire losses based on alleged material misrepresentations the insureds made in their claim.
TRENTON, N.J. – Charles B. Boas, 73, of Matawan, N.J., was indicted on 261 counts of second-degree health care claims fraud, second-degree theft by deception, two counts of third-degree failure to file tax returns, and two counts of third-degree failure to pay taxes. The indictment was returned by a grand jury on December 10, 2021. The … Read more
