Bergen County Doctor Charged with Fraudulently Billing for Office Visits That Were Never Rendered

A family medicine physician with offices in Cresskill and Little Falls was arrested Monday and charged with fraudulently billing Medicare, Medicaid and private health care insurance companies hundreds of thousands of dollars for physician office visits that were never rendered, U.S. Attorney Paul J. Fishman said.

Albert Ades, 60, of Englewood, was indicted by a federal grand jury in Newark on Feb. 20 on one count of health care fraud and 35 counts of making false statements relating to health care matters.

According to the indictment:

From 2005 through June 2014, Ades, a licensed family medicine doctor who owns and operates Albert Ades M.D., P.A., fraudulently billed insurers for face-to-face physician office visits, though he wrote prescriptions, authorized refills, or performed other tasks without ever seeing those patients on the billed dates, Fishman said.

Ades is also accused of altering, and instructing individuals working at his medical practice to alter, patients’ medical charts by inserting fabricated blood pressure readings, among other notations, to make it appear as if patients had visited his office on dates for which he billed their insurance plans.

To conceal his scheme, Ades altered patients’ medical records to make it appear as if patients had been seen at his office, when in fact they had not been, according to Fishman. When one insurance plan initiated an audit after a patient reported Ades for billing prescription refills as office visits, Ades allegedly shredded original medical records and created bogus ones to obstruct the audit. Between 2008 and 2013, at least four individuals working at Ades’s medical offices told Ades that his billing of prescription or refills out as office visits was illegal.

According to Fishman, the charge of healthcare fraud carries a maximum penalty of up to 10 years in prison and each of the 35 charges of making a false claim as to health care matters carries a maximum penalty of up to five years in prison. Each count in the indictment carries a maximum fine of $250,000 or twice the gross gain or loss resulting from the crime.