A family medicine physician with offices in Cresskill and Little Falls was arrested this morning and charged with fraudulently billing Medicare, Medicaid and private health care insurance companies hundreds of thousands of dollars for physician office visits that were never rendered, U.S. Attorney Paul J. Fishman announced.
Albert Ades, 60, of Englewood, was indicted by a federal grand jury in Newark on Feb. 20, 2015, on one count of health care fraud and 35 counts of making false statements relating to health care matters. The indictment was unsealed today. Ades is scheduled to appear later today before U.S. Magistrate Judge Steven C. Mannion in Newark federal court.
According to the indictment:
Ades, a licensed family medicine doctor who owns and operates Albert Ades M.D., P.A., fraudulently billed insurers for face-to-face physician office visits. Instead, he wrote prescriptions, authorized refills, or performed other tasks, without ever seeing those patients on the billed dates. Ades altered, and instructed individuals working at his medical practice to alter, patients’ medical charts by inserting fabricated blood pressure readings, among other notations, to make it appear as if patients had visited Ades’s office on dates for which Ades had billed their insurance plans.
From 2005 through June 2014, Ades billed Medicare, Medicaid and various private payors for physician office visits with patients on dates when he, in fact, had written prescriptions, authorized refills, or performed other tasks, without ever having seen those patients on the billed dates. To conceal his scheme, Ades altered patients’ medical records to make it appear as if patients had been seen at his office, when in fact they had not been there. When one insurance plan initiated an audit after a patient reported Ades for billing prescription refills as office visits, Ades shredded original medical records and created bogus medical records to obstruct the audit. Between 2008 and 2013, at least four individuals working at Ades’s medical offices told Ades that his billing of prescriptions or refills out as office visits was illegal.
The charge of health care fraud carries a maximum penalty of up to 10 years in prison. Each of the 35 charges of making a false claim as to health care matters carries a maximum penalty of up to five years in prison. Each count in the indictment carries a maximum fine of $250,000 or twice the gross gain or loss resulting from the crime.