Doctor Admits Billing Medicare, Other Insurers $3 Million for Therapy Services Performed by Unqualified Personnel
NEWARK, N.J. – A doctor with offices in Paterson, New Jersey, Passaic, New Jersey, and Elizabeth, New Jersey, today admitted defrauding Medicare and private insurance companies out of $3 million by billing for more than 150,000 physical therapy sessions that were performed by unlicensed and unqualified personnel, Acting U.S. Attorney William Fitzpatrick announced.
Anthony J. Enrico, 60, of North Haledon, New Jersey, pleaded guilty before U.S. District Judge Kevin McNulty in Newark federal court to an information charging him with one count of health care fraud.
According to the documents filed in the case and statements made in court:
From January 2007 through May 2016, Enrico billed Medicare and other health insurance providers for physical therapy services that he supposedly provided to his patients. In order for them to be reimbursable, Medicare and private insurers required that physical therapy services be performed only by individuals like Enrico who met certain criteria based on training and certifications.
Enrico admitted that on more than 150,000 occasions, those services were performed at his direction by individuals who lacked the necessary training and certifications, resulting in him fraudulently obtaining approximately $3 million from Medicare and private insurers.
Enrico faces a maximum potential penalty of 10 years in prison and a fine of up to twice the loss caused by the offense. As part of his plea agreement, Enrico must also pay restitution of $3 million. Sentencing is scheduled for Jan. 25, 2018.
Acting U.S. Attorney Fitzpatrick credited special agents of the U.S. Department of Health and Human Services – Office of the Inspector General, under the direction of Special Agent in Charge Scott Lampert, and the FBI, under the direction of Special Agent in Charge Timothy Gallagher in Newark, with the investigation.
The government is represented by Senior Litigation Counsel Joseph N. Minish of the U.S. Attorney’s Health Care and Government Fraud Unit and Assistant U.S. Attorney Elaine Lou of the U.S. Attorney’s Office Criminal Division.
The U.S. Attorney’s Office for the District of New Jersey reorganized its health care practice in 2010 and created a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since that time, the office has recovered more than $1.36 billion in health care and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act, and other statutes.
Defense counsel: Christopher D. Adams Esq., Holmdel, New Jersey