ENGLEWOOD, N.J. -- An Englewood family doctor with offices in Cresskill and Little Falls was sentenced to more than three years in federal prison Monday for defrauding Medicare, Medicaid and private insurance companies out $280,000 by billing them for non-existent office visits.
Albert Ades, 61, pleaded guilty U.S. District Court in Newark last August to a single count of health care fraud. In exchange, federal prosecutors dropped 35 counts of making false statements.
Ades admitted that he altered patients’ medical charts by inserting fabricated blood pressure readings, other vitals and clinical notes on patients’ charts to make it appear as if they had visited his office on the billed dates.
He also admitted that, between 2009 and 2013, his scheme caused a loss of approximately $280,000 to federal health care benefit programs and private insurers.
According to U.S. Attorney Paul J. Fishman:
“Ades, a licensed family medicine doctor who owns and operates Albert Ades M.D., P.A., fraudulently billed insurers for face-to-face physician office visits. Instead, he wrote prescriptions, authorized refills, or performed other tasks, without ever seeing those patients on the billed dates.
“Ades altered, and instructed individuals working at his medical practice to alter, patients’ medical charts by inserting fabricated blood pressure readings, among other notations, to make it appear as if patients had visited Ades’s office on dates for which Ades had billed their insurance plans.
“From 2005 through June 2014, Ades billed Medicare, Medicaid and various private payors for physician office visits with patients on dates when he, in fact, had written prescriptions, authorized refills, or performed other tasks, without ever having seen those patients on the billed dates.
“To conceal his scheme, Ades altered patients’ medical records to make it appear as if patients had been seen at his office, when in fact they had not been there. When one insurance plan initiated an audit after a patient reported Ades for billing prescription refills as office visits, Ades shredded original medical records and created bogus medical records to obstruct the audit.
“Between 2008 and 2013, at least four individuals working at Ades’s medical offices told Ades that his billing of prescriptions or refills out as office visits was illegal.”
Fishman credited the Newark FBI office, agents with the U.S. Department of Health and Human Services Office of Inspector General, and investigators with his office.
The government is represented by Jane H. Yoon and Danielle M. Corcione of Fishman’s Health Care and Government Fraud Unit in Newark.
In addition to the prison term, a federal judge sentenced Ades to three years of supervised release and ordered him to forfeit $280,000.