AG: Jersey City doctor charged with using a ‘runner,’ inflating insurance claims

A Jersey City neurologist was arrested today for allegedly paying a “runner” to bring in patients, then subsequently inflating the resulting insurance claims, Acting Attorney General John Jay Hoffman announced. 

By John Heinis/Hudson County View

Dr. Dan Dumitru, 44, with an office in Jersey City, is charged with two counts of second degree health care claims fraud, two counts of third degree criminal use of runners, two counts of fourth degree falsification of medical records and one count each of third degree conspiracy to use a runner.

The alleged scam was exposed by undercover Office of the Insurance Fraud Prosecutor detectives.

Dumitru paid a runner to recruit patients to his Big Apple Neurology office in Jersey City but unbeknownst to the doctor, the “patients” delivered by the runner were actually undercover detectives for the OIFP, according to the indictment.

Afterwards, Dumitru treated two undercover officers and then overbilled their insurance company for the care he provided, officials said.

Dumitru also allegedly provided two undercover detectives with medical treatment in the spring of 2015. Both detectives complained of nerve trouble in their hands, and both time,s Dumitru performed non-needle nerve testing on the patients, as charged in the indictment.

However, when Dumitru submitted the invoices to Horizon Blue Cross/Blue Shield, he falsely claimed to have performed more costly needle testing, authorities said.

Dumitru is also charged with violating New Jersey’s “anti-running statute,” which imposes criminal penalties for acting as a runner or using, directing, or employing a runner.

The statute defines a runner as:

“a person who attempts to procure a patient at the direction of, request of or in cooperation with a health care professional in exchange for a pecuniary benefit, when the health care professional intends to assert a claim against an insured person or an insurance carrier for providing services to the patient.”

The anti-running statute carries a presumptive sentence of three to five years in state prison, as well as other penalties.

Dumitru met with the runner, who is an unindicted co-conspirator in the case, on several occasions and agreed to pay $100 for each patient, even though the doctor appeared to be aware that his actions were against the law, authorities said.

“It’s fraud like this that corrupts the insurance system and causes New Jersey’s consumers to suffer increased insurance rates,” Hoffman said in a statement.

“The fact that a member of the medical profession allegedly chose to enrich himself with undeserved insurance payments instead of providing proper care to his patients is especially disturbing.”

Second-degree crimes carry a sentence of five to 10 years in state prison and a fine of up to $150,000, third-degree crimes carry a sentence of three to five years in jail and a fine of up to $15,000 and fourth-degree crimes carry a maximum sentence of 18 months in prison and a $10,000 fine.