Doctor Sentenced To 3 Years In Insurance Fraud Case

A Bergen County doctor was sentenced on March 14 to more than three years in prison by a judge who said his decision to bill insurers for patient office visits that never happened reminded her of Robin Hood.

During a two-hour hearing in Newark, U.S. District Judge Esther Salas flatly rejected a request by Albert Ades, 61, of Englewood, to be placed on probation with a period of home confinement and community service.

Instead, she sentenced Ades to 37 months behind bars and ordered him to pay $280,000 in restitution to the public and private insurance carriers that were defrauded by his scheme.

"I've suffered greatly as a result of what I've done and I'm very ashamed and humiliated," Ades, who has surrendered his medical license, told the judge in a courtroom packed with about 70 family, friends and supporters. "I just want to put it past me and get back to my community," he said.

Ades, a family medicine doctor with offices in Cresskill and Little Falls, was arrested 13 months ago and charged with fraudulently billing Medicare, Medicaid and private health care insurance companies for face-to-face physician office visits that never occurred.

Ades wrote prescriptions, authorized refills, or performed other tasks, without seeing his patients on the billed dates. He also altered, and directed staff 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 the dates in question.

Defense lawyer Alexander Spiro urged the judge to be spare Ades a prison term, arguing he "is a good man" who devoted his entire life to helping his patients and the community.

Rising from "humble beginnings," Ades put himself through medical school and over "decades did unbelievable work," volunteering his time for police, firefighters and school children, among others, his lawyer said.

But while he was a good doctor, and "selfless with his time," he was a "bad business person" and his practice struggled to the point where it is now gone and he is bankrupt, said Spiro, noting for years Ades performed medical services without charge.

While it is hard for those who know him to understand why he did it, it was not greed, Spiro said.

Assistant U.S. Attorney Danielle Corcione urged the judge to impose a prison term at the high end of the sentencing guidelines range of 33 to 41 months, noting that four of the doctor's employees had warned him that billing for office visits when none occurred was wrong and illegal.

Corcione also said Ades' manipulation of patient charts could have imperiled them if someone had relied on the false information.

When one insurer began an audit after a patient reported Ades for billing prescription refills as office visits, Ades shredded original medical records and created bogus records to obstruct the audit, authorities said.

Salas said that as a doctor, Ades was in a position of trust which he violated by submitting the false bills. If people don't obey the law there would be anarchy and the health care system would collapse, she said.

Trying to understand his motivation, Salas compared Ades to Robin Hood stealing from the rich insurance providers while being generous to the people, his patients.

"That's what Dr. Ades thought he was doing. It is a serious offense," she said.

She also noted that in his remarks, Ades recounted how he has suffered greatly, but she didn't hear an apology or any remorse.

In order to deter others, she said, a message must be sent that if a doctor violates his position of trust and commits fraud the consequences will be severe and will involve a term of imprisonment.

While Ades may have been an especially good and generous doctor in the eyes of his patients, his fraud was no solitary incident but spanned a decade from 2005 to 2014, the judge said.

The judge allowed Ades to remain free until May 2 when he must surrender to prison authorities to begin serving his sentence.

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