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Alfredo Valdes, Jr., 43, admitted in August that he submitted the bogus claims to Horizon NJ Health, a provider of Medicaid services in the state, through his T-N-T medical supplies company in the Hudson County city of West New York from January 2008 to March 2016.
The durable medical equipment – including compression stockings, diapers and other items – were reimbursed in the name of patients who, in fact, were dead, state Attorney General Gurbir S. Grewal said.
Besides the prison term, Valdes was ordered $101,000 in restitution to Horizon New Jersey Health, and sign a consent order agreeing to lifetime disbarment from participation as a provider in the New Jersey Medicaid program.
“Valdes systematically stole from Medicaid, billing the program more than $100,000 for medical supplies for patients who were deceased,” Grewal said. “This prison sentence reflects the egregious nature of his conduct, as well as our resolve to fight Medicaid fraud and preserve program funding for our residents who otherwise could not afford health care.”
“Every dollar lost to Medicaid fraud is one less dollar available to help some of the most vulnerable citizens of our state,” said Acting Insurance Fraud Prosecutor Christopher Iu.
Deputy Attorney General Melissa Simsen represented the state in the case, investigated by Detectives Anthony Iannice and Kylie Mattis with assistance from the Special Investigation Unit at Horizon New Jersey Health, and Analysts Keira McRae-Wiggins and Kelly Celenza.
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NOTE: Some biggest insurance fraud cases have begun with anonymous tips. Anyone with information about a fraud can report it anonymously by calling a toll-free hotline at 1-877-55-FRAUD, or going to: www.NJInsurancefraud.org. Rewards are paid to those who provide information leading an arrest, prosecution and conviction for insurance fraud.
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