Doctor Indicted for Insurance Fraud

ELIZABETH — Earlier this week, a Union County Grand Jury handed down a 74-count indictment against a Union Township doctor and his brother after an investigation revealed that they submitted millions of dollars in allegedly fraudulent Medicare and private insurance health care claims, Prosecutor Theodore J. Romankow announced.

Dr. Amgad Hessein, 54, of Advanced Pain Management Specialists, formerly headquartered in Union Township and currently located in South Orange, and his brother were arrested last November. Hessein and his brother Ashraf Sami, 57, were indicted on Wednesday, said Romankow.

The case began in April 2009 in Union Township when Sami, an office manager at Advanced Pain Management Specialists, reported a theft by an employee to the local police department, said Romankow. During that investigation by Union Township Police Department detective William Fuentes, “it became clear that Dr. Hessein and Advanced Pain Management Specialists were involved in a scheme of overbilling, upcoding and submitting fraudulent claims for treatments not rendered,” said Romankow.

The Union County Prosecutor’s Office Insurance Fraud Unit and the New York Regional office of the United States Department of Health and Human Services, Office of the Inspector General joined the investigation. According to the investigation, Advanced Pain Management Specialists fraudulently billed Medicare, Medicaid and private insurance between January 2006 and 2010, Romankow said.

The investigation revealed that Dr. Hessein submitted claims for every day of the year in 2006 and 2007 and on multiple occasions his billable hours exceeded 24-hours on many days, said Romankow.

“Bank records revealed that the doctor had billed for treatments for which he did not have the equipment to perform, would bill patients for higher level, more costly treatments than were actually performed and would bill for visits when patients were not even in the office,” said Romankow. “On many occasions the doctor billed for treatments that he allegedly performed in his office while he was actually out of the country.”

Prosecutor’s Office Detective David Nechamkin and Special Agents with the U.S. Department of Health and Human Services investigated the case. Union County Assistant Prosecutor Michael Sheets will prosecute the case. The Union Township Police Department, the Union County Police Department, the Monmouth County Prosecutor’s Office and the New Jersey Division of Consumer Affairs Enforcement Bureau assisted with the arrests and search warrant execution.

These criminal charges are mere accusations. The defendants are presumed innocent until proven guilty in a court of law.

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