Acting Attorney General John Hoffman and the Office of Insurance Fraud Prosecutor today announced that a North Jersey doctor has been indicted for allegedly billing numerous insurance carriers for medical procedures he did not perform himself or that were not performed at all.
Gautam Sehgal, a neurologist with practices in Newark, Perth Amboy, Clifton, Elizabeth, South Orange and Paterson, was charged by a state grand jury with seven counts of health care claims fraud in the second degree for allegedly filing fraudulent bills to insurance carriers.
The 52-year-old Livingston resident was also charged with one count of second-degree insurance fraud and one count of third-degree theft by deception in connection with the alleged fraudulent claims.
According to the Indictment handed up in Middlesex County Superior Court, Sehgal filed seven health care claims fraudulently stating he had performed a diagnostic procedure known as needle Electromyography (EMGs) on seven patients. In six of the cases an unlicensed technician, not Sehgal, performed the procedures. In the case of the seventh claim, no needle EMG was performed at all.
According to the indictment, Sehgal filed potentially fraudulent claims to nine carriers between July 2008 and October 2013. The health care claims indictments stem from seven claims submitted between February 2011 and October 2013 to: 21st Century Insurance Company, Travelers Insurance Company, Encompass Insurance Company, and Metropolitan Life Insurance Company. The theft by deception charges stem from the above claims and earlier claims submitted to: Allstate Insurance Company, Farmers Insurance Company, Progressive Insurance Company, AIG Insurance Company, and NJ Cure Insurance Company.
Deputy Attorney General Dennis Kwasnik presented the case to the grand jury. Detective coordinated the investigation with assistance from Travelers Insurance
Company, 21st Century Insurance Company, Metropolitan Life Insurance Company, State Farm Insurance Company, Progressive Insurance Company, Farmers Insurance, NJCure Insurance Company, Encompass Insurance Company, and Allstate Insurance Company.
Second-degree crimes carry a sentence of five to 10 years in state prison and a criminal fine of up to $150,000; third-degree crimes carry a sentence of three to five years in state prison and a criminal fine of up to $15,000.
People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll‑free hotline at 1‑877‑55‑FRAUD, or visiting the Web site at www.NJInsurancefraud.org.