Faces Five-Year Prison Sentence for Health Care Claims Fraud

TRENTON

– Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor (“OIFP”) announced today that a Bergen County family practitioner is facing five years in prison for submitting more than $32,000 in false claims to an insurance company for health care services he never rendered.

Dr. Robert Delagente, 45, of Oakland, who practiced at North Jersey Family Medicine, pleaded guilty to a one-count accusation charging him with second-degree health care claims fraud. Under the terms of the plea agreement, the State will recommend that Delagente be sentenced to five years in prison. Delagente is scheduled to be sentenced on January 10, 2020.

In pleading guilty before Superior Court Judge James X. Sattely in Bergen County on Nov. 21, 2019, Delagente admitted that between May and December of 2016 he submitted seven fraudulent claims to Blue Cross/Blue Shield of New Jersey totaling $32,006.

The fraudulent claims billed the insurance company for allergy testing and immunotherapy services that Delagente did not provide to patients.

“When doctors cheat the insurance system, they’re committing a crime that drives up the cost of healthcare for everyone, including the patients they took an oath to serve,” said Attorney General Grewal. “The five-year prison sentence this doctor faces sends a message that New Jersey will not tolerate medical providers who abuse their professional authority for illegal gain.”

“Insurance fraud costs insurance companies billions of dollars every year nationwide and those losses are passed on to all of us through higher insurance premiums and increased costs for goods and services,” said Acting Insurance Fraud Prosecutor Tracy M. Thompson. “To protect New Jersey residents from being victimized by insurance cheats we will continue to pursue harsh punishments like the one announced today to send a strong message of deterrence.”

Deputy Attorney General Crystal Callahan represented the State during the plea hearing.

Delagente was charged following a joint investigation of his practice by OIFP and the FBI. The investigation was coordinated by OIFP Detectives Suzanna Lopez and Janet Thai, and special agents with the FBI Health Care Fraud Unit.

Delagente also faces criminal charges in federal court stemming from this investigation.

On May 13, 2019, the

U.S. Attorney’s Office of the District of New Jersey charged Delagente

with one count of distribution of controlled dangerous substances for allegedly prescribing opioid pain medications and other controlled substances outside the ordinary course of professional practice, and one count of obstruction of justice for allegedly falsifying medical records to cover it up.

In the wake of the federal charges against him, Delagente entered an

Interim Consent Order

with the State Board of Medical Examiners in which he agreed to the temporary suspension of his license pending the outcome of those charges and pending further action by the Board.

Acting Insurance Fraud Prosecutor Thompson noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll-free hotline at

1-877-55-FRAUD

, or visiting the Web site at

www.njinsurancefraud.org

. State regulations permit a reward to be paid to an eligible person who provides information that leads to a conviction for insurance fraud.

Final Decision

Initial Decision

NEWARK

– Attorney General Gurbir S. Grewal and the Division of Consumer Affairs today announced that the State Board of Dentistry (“the Board”) revoked the license of a North Jersey oral and maxillofacial surgeon and ordered him to pay more than $500,000 in penalties, costs, and restitution to patients for engaging in “hit and run dentistry” that left a swath of harmful consequences for patients in four counties.

Dr. Andrew Maron, who owned a string of dental practices in Monmouth, Passaic, Hudson, and Union counties, and also practiced as an itinerant oral surgeon in those counties, has been prohibited from practicing in New Jersey since the State filed multiple allegations of negligence, gross negligence and professional misconduct against him in 2015.

In a final decision that brings closure to the State’s case, the Board revoked the license of the 58-year-old Maron, finding that his treatment of patients – many of whom were low-income, elderly, or disabled – amounted to “hit and run dentistry” that reflected a “cavalier indifference to his patients’ well-being” and a “pattern of substantial deviations from the standard of care that existed unabated for years.”

“Most dental practitioners are dedicated to the health and safety of their patients,” said Attorney General Grewal. “But revolving-door dentistry that puts practitioners’ financial gain ahead of patient health and safety erodes public trust and undermines the integrity of the entire profession. That’s why it’s important for the Board to take decisive action in cases like this one, and we are pleased that the Board did so.”

According to findings in the case, Maron committed multiple acts of negligence and gross negligence and professional misconduct in his treatment of 17 patients between 2010 and 2015. Such conduct included:

Pulling natural teeth and replacing them with dental implants with little or no regard to the restorability of the natural tooth;

Placing numerous implants that failed, some dangerously so by migrating into the sinus, or by patients swallowing them;

Performing, planning and undertaking treatment without regard to a patient’s ability to pay for the treatment;

Discussing treatment with patients who were already in the chair receiving anesthesia;

Pressuring elderly patients into having implants placed without pre-operative diagnosis, review, or informed consent;

Pressuring Medicaid patients into taking CareCredit loans which exceeded their ability to repay;

Ignoring or failing to take patients’ medical histories;

Submitting inaccurate and inflated billing for treatment; and

Failing to ensure that the dentists in his employ practiced with patients\’ health, safety, and welfare in mind.

“Dr. Maron placed patients at risk through egregious conduct that violated the most basic tenets of professionalism,” said Paul R. Rodríguez, Acting Director of the Division of Consumer Affairs. “His disregard for the well-being of his patients makes a mockery of the standards adhered to by those who are privileged to hold a license to practice dentistry. The revocation of his license not only protects the public from the threat posed by Dr. Maron, it removes a stain on New Jersey’s esteemed dental profession.”

The Board\’s decision to revoke Maron’s license largely upholds the findings of an Administrative Law Judge who heard the case in a series of hearings that concluded in January 2019.

In an Initial Decision rendered in May 2019, Administrative Law Judge Susan M. Scarola concluded that Maron’s practice was “so overextended it was almost impossible for him to provide quality care.”

“Respondent’s repeated acts of negligence and gross negligence, his professional misconduct, his dishonesty and deception, and his lack of providing appropriate and determined care for his patients warrant the severest possible sanction, namely, revocation of his license,” Judge Scarola concluded.

Judge Scarola also agreed with the State’s argument that Maron should be ordered to pay a substantial penalty for each unlawful act he committed, and that he be ordered to reimburse patients for deficient treatment, and reimburse the State for fees and costs associated with investigating and prosecuting the case.

Following a hearing on July 24, 2019, the Board adopted Judge Scarola’s findings and conclusions with limited modifications. Those modifications lowered the amount of restitution to one patient, and removed restitution to another patient who already received payment through civil litigation.

The Board ordered Maron to pay civil penalties totaling $138,500; restitution totaling $75,041.22 to 15 patients; and aggregate costs and attorneys\’ fees of $303,856.22. The Board filed its written decision on Nov. 1, 2019.

This investigation was conducted by the Enforcement Bureau of the Division of Consumer Affairs.

Senior Deputy Attorney General Joan D. Gelber, from the Division of Law represented the State in this matter.

Patients who believe that they have been treated by a licensed health care professional in an inappropriate manner can file an online complaint with the State Division of Consumer Affairs by visiting its

website

or by calling

1-800-242-5846

(toll free within New Jersey) or

973-504- 6200

.