• Dean Smith

New Jersey Woman Pleads Guilty to Submitting $500K in Fraudulent Med Claims

According to Kathleen Hopkins of the Asbury Park Press, 40-year-old Middletown resident, Donna Dzienisewski, plead guilty to healthcare claims fraud last month, admitting that she submitted over $500,000 in fraudulent insurance claims for medical procedures she never received.

Acting Attorney General John J. Hoffman and acting Insurance Fraud Prosecutor Ronald Chillemi stated in a news release that Dzienisewski admitted to Superior Court Judge Anthony J. Mellaci Jr. that between March 18, 2011 and March 12, 2013, 107 claims were submitted to Horizon Blue Cross Blue Shield of New Jersey for approximately $502,740 in healthcare expenses, including 107 doctor visits.

However, an investigation launched after Dzienisewski was paid $141,126 by HBCBS of NJ. As the rest of her claims were pending, investigators determined that she had only incurred six doctor visits between March 18, 2011 and March 12, 2013. The expenses for those visits should have totaled $2,640, according to the news release. But for those particular visits, Dzienisewski claimed the expenses totaled $8,640.

The sentencing hearing is scheduled for February 6, 2015. Dzienisewski’s plea deal saved her from spending up to 10 years in prison. As part of the plea bargain, the state will recommend a five-year sentence, repayment of $10,000 in restitution, and a civil consent judgment totaling $50,000.

Since most of the money Dzienisewski collected from the insurer has been spent, the civil consent judgment will place a lien on her assets and will ensure that if she ever stumbles upon some money, it can be recovered.


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#claims #fradulent #fraud #medical

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