New Jersey Social Worker Confesses to Insurance Fraud

Post Date June 27, 2012 –  A New Jersey social worker will be facing a probation sentence after pleading guilty to committing third degree health insurance –related fraud.   State Attorney General Jeffrey Chiesa had announced recently that Rashmi Gupta, 39 years old, had pleaded guilty to the act of defrauding Medicaid by submitting unscrupulous time sheets pertaining to counseling services of troubled teenagers.  Gupta’s sentencing was scheduled on June 22 before Judge Clark. With her pleading guilty, New Jersey’s Office of the Insurance Fraud Prosecutor had recommended her to probation, and that she will be banned from reimbursement through the Medicaid for five years. With regards to her profession, Gupta’s case has already been brought up to the New Jersey Board of Social Work Examiners for possible actions on her social work license.

Gupta who worked with the TYSN (The Youth Success Network) in Passaic, had disclosed that between July and December 2010, time sheets for counseling services even if none was provided.  With her fraudulent time sheets, TYSN demanded claims from the Medicaid and then paid Gupta. Based on the social worker’s timesheets, she was paid for $10,177.50 for services that never existed.  Ronald Chillemi, Insurance Fraud Prosecutor, had said Gupta’s fraud schemes and other fraud on health insurance in NJ continues to thrive, stealing huge amounts of the state’s tax dollars.

Gupta’s scheme was discovered when one client reported to TYSN that the social worker did not render them such services. With this information, TYSN notified the Office of the Insurance Fraud Prosecutor. The case was then thoroughly investigated by Medicaid Fraud Control through unit acting chief Nicole Rizzolo, Deputy Atty. Gen. Dolores Blackburn, and Detective Luisa Sanchez. Gupta’s probation sentence is due to a state law that if a person is found guilty with a third-degree crime but not previously convicted of any indictable offense, that person’s incarceration sentence can be presumed against.

On a personal note; insurance fraud is on the rise.  Anyone whom has followed my Blog knows I focus a fair amount of attention to car insurance fraud and the effect this has on the auto insurance industry. Sadly, there are far more people whom are aware of those whom commit insurance fraud than actually perpetrate the crime.  The sad thing is; the cost of insurance fraud is built into the premium of every car insurance policy in New Jersey.  Believe it or not, a $1000.00 auto insurance premium would be less than $700.00 if there was no insurance fraud.  The next time you hear about someone about to defraud an insurance company – think about how much that act has cost you over the last 10 years.


Michael E. Dortch
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