N.J. Resident with Revoked Medical License Charged in Fraud Scam

New Jersey Criminal Justice Director Vaughn McKoy reported that the Division of Criminal Justice – Office of Insurance Fraud Prosecutor has obtained an indictment charging a Morris County resident whose New York medical license had been revoked, with theft for his reported role in an insurance fraud scam.

According to Insurance Fraud Prosecutor Greta Gooden Brown, Craig W. Gordon, 48, of Chatham, Morris County, was charged with Health Care Claims Fraud (2nd degree), theft by deception and practice of medicine by unlicenced person (both 3rd degree). If convicted on all counts, Gordon faces up to 20 years in state prison and a criminal fine of up to $180,000. In addition, Gordon faces civil insurance fraud fines.

The Morris County Grand Jury indictment alleges that between Jan. 26, 2000 and Jan. 18, 2001, Gordon, a former doctor whose State of New York medical license was revoked in 1995, operated a business known as GFM Health Services out of his residence.

It is charged that Gordon referred to himself as “Dr. Gordon” while taking patients’ pulses and blood pressures. According to the indictment, Gordon caused claims to be submitted to Horizon Blue Cross/Blue Shield of New Jersey (HBCBSNJ) through the Medicare program for treatments to two patients for these services.

An investigation by the Division of Criminal Justice – Office of Insurance Fraud Prosecutor determined that the claims created the false impression that health care services had been provided by another physician when, in fact, they were either provided by Gordon, who is not a practitioner, or not provided at all.

It is charged that as a result of the alleged scam, HBCBSNJ paid out more than $10,900 in claims.