CNBNews

Donna Dzienisiewski, 40, of Middletown, was charged yesterday (April 24) with second-degree health care claims fraud, second-degree attempted theft by deception, second-degree theft by deception, second-degree identity theft, and fourth-degree falsifying records.

“This indictment alleges that the defendant callously attempted to defraud her insurance company of half a million dollars, ultimately obtaining more than $140,000,” Acting Attorney General Hoffman said. “These types of fraudulent activities drive up the cost of insurance premiums for law-abiding residents of New Jersey.”

"Submitting false health care claims to insurance companies strikes at the heart of New Jersey's health care system because it steals money directly from the sources used to treat illnesses for New Jersey's honest residents.” Acting Insurance Fraud Prosecutor Ronald Chillemi said. “This atrocious behavior will be prosecuted vigorously by the Office of the Insurance Fraud Prosecutor."

The state grand jury indictment alleges that between March 18, 2011 and March 12, 2013, Dzienisiewski submitted 107 claims to Horizon Blue Cross Blue Shield of New Jersey that gave the false impression that the defendant incurred approximately $502,740 in total reimbursable expenses for health care services. The indictment alleges that Dzienisiewski never actually visited the doctor on approximately 101 of those occasions and incurred no medical expenses at all on those 101 occasions. It is further alleged that she incurred only approximately $2,640 in medical expenses for the remaining six claims, even though she altered the six medical invoices corresponding to these claims to show falsely that she incurred a total of $8,640 in medical expenses. As a result of the alleged fraud, Dzienisiewski received $141,126 from Horizon Blue Cross Blue Shield of New Jersey to which she was not entitled.

The indictment further alleges that, in an attempt to support the fraudulent claims, Dzienisiewski stole the doctor’s identity, placing his name, address, telephone and fax numbers, and tax identification number on each of the claims that were submitted to Horizon Blue Cross Blue Shield of New Jersey. Dzienisiewski is currently registered as a nurse, although her profession is unrelated to the alleged crime.

Deputy Attorney General T.J. Harker and Detectives Wendy Berg and Matthew Armstrong coordinated the investigation. Analyst Kelly Celenza provided substantial assistance in the financial analysis of the investigation. Acting Insurance Fraud Prosecutor Chillemi thanked Horizon Blue Cross Blue Shield of New Jersey for referring the matter to the Office of the Insurance Fraud Prosecutor.

The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of up to $150,000 while fourth-degree crimes carry a maximum sentence of 18 months in state prison and a criminal fine of up to $10,000.