N.J. Doc, Niece Plead Guilty to Insurance Fraud

New Jersey Attorney General Peter Harvey announced that an Essex County doctor and his niece have pleaded guilty to multiple counts of insurance fraud, including submitting more than $48,000 in insurance claims for services that were never provided to patients.

According to Vaughn McKoy, director, Division of Criminal Justice, and Insurance Fraud Prosecutor Greta Gooden-Brown, Dr. LeClerc Adisson, 58, of Irvington, Essex County, and his niece, Lunic Adisson, 34, same address, pleaded guilty before Essex County Superior Court Judge Paul Vichness to criminal charges contained in a criminal Accusation and two separate indictments.

In pleading guilty to a charge of theft by deception contained in a State Grand Jury indictment, Dr. Adisson, the former owner of Laguardia Primary Health Care, 108 South Munn Ave., East Orange, Dantor Medical Supply and Clara Medical Services, and Lunic Adisson (niece) reportedly admitted that from April, 1997 through December, 2000, they improperly treated and referred patients to the various Adisson-owned facilities.

As a result of those actions, Adisson inflated claims for services and medical supplies that were not prescribed by a treating chiropractic physician and then sought payment for those services and supplies that were not provided to patients.

The investigation determined that $48,273 in fraudulent bills were submitted to several insurance companies including Zurich Insurance Group, Century Insurance Company, New Jersey Manufacturers Insurance Company, Progressive Insurance Company, MDA Insurance Company, Liberty Mutual Insurance Company, Keystone Insurance Company, Prudential Insurance Company, Clarendon Insurance Company, and State Farm Insurance Company.

In pleading guilty to charges of Health Care Claims Fraud and Criminal Use of Runners as contained in the Accusation, Adisson admitted that between February, 2000 and September, 2001, he and another chiropractor (not named as a defendant) submitted false auto insurance Personal Injury Protection (PIP) claims to Parkway Insurance. Adisson admitted that he employed a “runner” to procure additional patients in order to beef-up the submission of insurance claims.

In using a “runner” and in recklessly using the other chiropractor’s false treatment notes, Adisson was reportedly able to increase the amount of claims submitted to insurance companies. Additionally, Adisson admitting that referrals for MRI services came from an outside medical chiropractor and that he paid a “runner” $100 for each MRI scan and $300 for every patient referred to his practice by the outside chiropractor for treatment. Parkway Insurance Company was billed $19,494 for treatments never provided to patients.

Gooden-Brown said that Lunic Adisson pleaded guilty to an unrelated charge of simulating a motor vehicle insurance identification card contained in a June 27, 2003 Essex County Grand Jury indictment. The indictment charged that Adisson produced and supplied a motor vehicle insurance identification card to an Irvington, Essex County, police officer in order to regain possession of her impounded vehicle. The charge arose from a separate investigation conducted by the Office of the Insurance Fraud Prosecutor regarding fake motor vehicle insurance identification cards.

The Adissons are scheduled to be sentenced by Judge Vichness on April 18. Second-degree crimes carry sentences of up 10 years in state prison and a fine of up to $150,000, while third degree crimes carry sentences of up to five years in state prison and a fine of up to $15,000. A fourth degree crime carries a sentence of up to 18 months in state prison and a fine of up to $10,000.

Additionally, Dr. Adisson and Lunic Adisson could face civil insurance fraud fines pursuant to the civil Insurance Fraud Prevention Act. The guilty pleas involving Dr. Adisson will be referred to the Board of Medical Examiners which licenses medical doctors in New Jersey.