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Gloria Andrade, 56, of Teaneck, was employed full-time as a social services specialist with the Township of Teaneck when she submitted the bogus claims while working a side job as a solo practitioner providing in-home counseling and therapy to children, adolescents, and their families in the NJ Department of Children and Families’ Intensive In-Community Services program (IICS), authorities said).
“Licensed health care providers who commit Medicaid fraud are a disgrace to their professions,” Attorney General Grewal said. “They are not only stealing from the New Jersey taxpayers who fund the Medicaid program: They are depriving much-needed services to individuals and families who cannot afford health insurance.”
IICS providers must document services rendered on Service Delivery Encounter Documents forms, which document the day and time services were provided.
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ALSO SEE: An X-ray tech conducted dental procedures at his wife's practices in Teaneck and Passaic – including putting braces on a 16-year-old girl who required remedial care – then lied about it with her to health insurers, authorities charged.
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Andrade sought reimbursement from Medicaid for 49 IICS services never rendered, a grand jury indictment returned in Trenton charges.
She billed and was paid for "conflict" claims for services that couldn’t have been rendered because she was either working at her full-time job as Teaneck's social services specialist or because the kids were actually in school at the time, it says.
Andrade also billed Medicaid for "overlap" services that provided on the same date, at the same time, to two or more children in different locations, the indictment says.
The indictment charges Andrade with health care claims fraud, Medicaid fraud, theft by deception and falsifying records.
Deputy Attorney General Fernando Maldonado presented the case to the grand jury, based on an investigation by Detective Laura Parisi with assistance from Analyst Elizabeth O’Brien, Grewal said.
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Anyone who is concerned about insurance cheating and has information about a fraud can report it anonymously by calling a toll-free state hotline at 1-877-55-FRAUD, or visiting the Web site at www.njinsurancefraud.org. Rewards are offered for information that leads to an arrest, prosecution and conviction for insurance fraud, said Acting Insurance Fraud Prosecutor Tracy M. Thompson. Some important cases have started with anonymous tips, she noted.
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