New Jersey Manufacturers Insurance Group announced that a New Jersey chiropractor has agreed to pay the West Trenton, N.J.-based insurer $1 million for conducting tests using unauthorized technicians, among them a 15-year-old boy.
The carrier said the settlement came after it sued Dr. Sean Nisivoccia for fraudulent nerve conduction velocity tests that were conducted at his chiropractic offices in East Orange, N.J. The tests were done on more than 60 individuals with auto accident claims from 1999 to late 2004.
The company said it brought an action against Dr. Nisivoccia in 2005 after the insurer's Special Investigations Unit discovered he ordered the test conducted by technicians, one of whom was a teenager. The discovery spurred an in-depth review by NJM of all relevant patient files, the company said.
NJM said that in order to administer the tests, which are used to ascertain whether nerve damage has occurred, state regulation requires a chiropractor to undergo formal training and obtain a certificate of competency. Records from the New Jersey Board of Chiropractic Examiners indicated that Dr. Nisivoccia did not earn an NCV certificate until December 2004, despite submitting bills for NCV tests since 1999.
NJM argued that because the tests themselves were illegal, all treatment expenses allegedly justified by the tests were fraudulently billed in violation of the New Jersey Insurance Fraud Prevention Act and should be recovered.
NJM's suit named another chiropractor and three doctors who allegedly referred patients to Dr. Nisivoccia for the illegal testing. NJM has provided evidence it obtained with regard to the case to the appropriate medical boards and the Office of the Insurance Fraud Prosecutor for further consideration.
"The Nisivoccia settlement will recover valuable funds for our policyholders and is a great accomplishment for our SIU," said Anthony G. Dickson, president and chief executive officer of NJM.
He added that "medical fraud involves more than just money. While most medical practitioners have the utmost concern for the well-being of their patients, dishonest doctors may take risks that can endanger their patients. Doctors who are proven to be dishonest should lose their licenses, be prosecuted to the fullest extent of the law and be sent to jail."
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