Local neurologist charged with insurance fraud

SOUTH ORANGE / NEWARK, NJ — 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, according to a Feb. 9 release from New Jersey acting Attorney General John Hoffman and the Office of Insurance Fraud Prosecutor.

Gautam Sehgal, a neurologist with practices in South Orange, Newark, Perth Amboy, Clifton, Elizabeth 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, or 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.

“The integrity of physicians is the lynchpin of the health care claims process,” Hoffman said in the release. ”Doctors who file false claims undermine that system and drive up health care costs for honest participants.”

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 the following insurance companies: 21st Century, Travelers, Encompass and Metropolitan Life. The theft by deception charges stem from the above claims and earlier claims submitted to Allstate, Farmers, Progressive, AIG and NJ Cure.

“The allegations against Dr. Sehgal, if proven, show an utter lack respect for his patients, his profession and the law,” acting Insurance Fraud Prosecutor Christopher Iu said in the release. ”Our office will not tolerate any doctor who blatantly cheats the system to satisfy his own greed.”

The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. 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.

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