NEWARK, N.J. – A North Caldwell, N.J., doctor was sentenced today to 24 months in prison for his role in defrauding Blue Cross Blue Shield of more than $725,000 by submitting false claims for services he never performed, U.S. Attorney Paul J. Fishman announced.
Dr. Michael P. Stein, 63, previously pleaded guilty before U.S. District Judge Esther Salas to an Information charging him with one count of defrauding Blue Cross Blue Shield by filing false claims for services that were not rendered and office visits that did not occur. Judge Salas also imposed the sentence today in Newark federal court.
According to documents filed in this case and statements made in court:
Between August 2004 and September 2010 Stein was the owner and operator of Randolph Otolaryngology P.C., a medical treatment facility. Stein treated a patient with the initials J.F. for nasal problems and billed Blue Cross Blue Shield for the services he purportedly performed.
Stein admitted he filed fraudulent claims with Blue Cross Blue Shield for medical procedures that were not performed during office visits. Stein submitted claims for approximately 900 nasal endoscopies he purportedly conducted on the patient, when only a few were actually performed. Stein also admitted he filed fraudulent claims for office visits and medical procedures that purportedly occurred while he was away on vacation. Between Sept. 6, 2010, and Sept. 27, 2010, Stein billed Blue Cross Blue Shield for 11 nasal endoscopies and 10 office outpatient visits for purported services rendered to J.F. In truth, J.F. ceased seeing Stein around Sept. 3, 2010, and Stein was in Germany from Sept. 11, 2010 through Sept. 27, 2010. Stein received $725,156.45 from Blue Cross Blue Shield as a result of his submission of the false claims, and, under the plea agreement, agreed to pay restitution and forfeiture in the same amount.
In addition to the prison term, Judge Salas sentenced Stein to three years of supervised release and ordered him to forfeit $725,156.45 and pay restitution of $725,156.45. He has also surrendered his medical license.
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