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ICYMI: Toms River Doctors Charged In Insurance Fraud Scheme

June 10, 2015 by  
Filed under Blog

A Toms River orthopedic doctor and a Toms River chiropractor are among four people accused of participating in an illegal patient referral scheme that allowed them to commit health insurance fraud and maximize the payouts they received, according to authorities.

Passaic County Prosecutor Camelia M. Valdes announced the arrest of Dr. Kenneth Gross, 44, and his wife, Dr. Michelle Dubnoff, 45, both of the Morganville section of Marlboro; Dr. James Morales, 45, of Toms River; and James Hill, 50, of Hasbrouck Heights.

Gross, a chiropractor, ran his practice out of Chiropractic Physicians Group in Passaic, and submitted false billing, false medical and chiropractic notes, Valdes said. Gross paid James Hill for illegal “running,” to refer patients to his practice so that he could treat them and then file claims with their insurance companies, she said.

Payments to James Hill were laundered and disguised. James Hill failed to pay New Jersey income tax returns on these funds, she said.

Dubnoff, a chiropractor, ran her practice out of Ocean Wellness Center, 1868 Hooper Ave., Suite 3, Toms River.

Morales ran his orthopedic practice out of Shore Sports Medicine, 1868 Hooper Ave., Suite 5.

Gross, Dubnoff and Morales engaged in an illegal referral scheme, referring patients to and among themselves to commit health care claims fraud and to maximize insurance payments, the prosecutor said.

Billing records were submitted by the defendants to various insurance carriers on behalf of Chiropractors Physician Group (Gross), Shore Sports Medicine (Morales), and Ocean Wellness Center (Dubnoff) that created or reinforced a false impression that said entities were independent of each other and referrals were made on an arm’s length professional basis for the best interest of the patients, she said.

In fact, the defendants and corporate entities they controlled are directly related by family and financial interconnection in violation of New Jersey State law, Valdes said.

Gross is charged with illegal running, conspiracy to commit health claims fraud, commercial bribery and health claims fraud.

Morales is charged with conspiracy to commit health claims fraud, commercial bribery and and health claims fraud.

Dubnoff is charged with conspiracy to commit health claims fraud.

Hill is charged with illegal running, conspiracy to commit health claims fraud, failure to file returns (tax evasion); failure to pay and money laundering.

Valdes thanked Ocean County Prosecutor Joseph Coronato and his office for assisting with the investigation, along with the New Jersey Attorney General’s Office, Office of the Insurance Fraud Prosecutor, the police departments of Passaic, Paterson, Toms River and Hasbrouck Heights, and the National Insurance Crime Bureau.

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