IN THE MATTER OF PROCEEDINGS BY THE COMMISSIONER OF BANKING AND INSURANCE, ETC. (NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE)

CourtNew Jersey Superior Court Appellate Division
DecidedFebruary 22, 2019
DocketA-2223-17T2
StatusUnpublished

This text of IN THE MATTER OF PROCEEDINGS BY THE COMMISSIONER OF BANKING AND INSURANCE, ETC. (NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE) (IN THE MATTER OF PROCEEDINGS BY THE COMMISSIONER OF BANKING AND INSURANCE, ETC. (NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE)) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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IN THE MATTER OF PROCEEDINGS BY THE COMMISSIONER OF BANKING AND INSURANCE, ETC. (NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE), (N.J. Ct. App. 2019).

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-2223-17T2

IN THE MATTER OF PROCEEDINGS BY THE COMMISSIONER OF BANKING AND INSURANCE, STATE OF NEW JERSEY TO FINE CHARLES BOAS PURSUANT TO THE NEW JERSEY INSURANCE FRAUD PREVENTION ACT, N.J.S.A. 17:33A-1 to -30. ______________________________

Submitted January 30, 2019 – Decided February 22, 2019

Before Judges Accurso, Vernoia and Moynihan.

On appeal from the New Jersey Department of Banking and Insurance.

Brach Eichler LLC, attorneys for appellant Charles Boas (Keith J. Roberts, of counsel and on the briefs; Shannon M. Carroll, on the briefs).

Gurbir S. Grewal, Attorney General, attorney for respondent Commissioner of Banking & Insurance (Melissa H. Raksa, Assistant Attorney General, of counsel; Adam B. Masef, Deputy Attorney General, on the brief).

PER CURIAM Appellant Charles Boas appeals from New Jersey Department of Banking

and Insurance (Department) orders denying his motion to vacate a final order

directing that he pay $500,000 in civil and administrative penalties for his

submission of 1011 fraudulent insurance claims, a $1000 statutory insurance

fraud surcharge, $53,384.52 in restitution and $3459 in attorneys' fees, and

denying his motion for reconsideration. Based on our review of the record in

light of the applicable law, we are convinced the Department's orders are

supported by substantial credible evidence and are not arbitrary, capricious or

unreasonable, and affirm.

I.

Boas is a licensed chiropractor in the State of New Jersey. In 2012, he

was charged in an indictment with sixty counts of second-degree health care

claims fraud, N.J.S.A. 2C:21-4.3(a), and one count of third-degree theft by

deception, N.J.S.A. 2C:20-4, for allegedly billing Horizon Blue Cross Blue

Shield (Horizon) for services he did not render. In April 2014, Boas pleaded

guilty to third-degree health care claims fraud and was sentenced in July 2014

to a two-year term of probation.

A-2223-17T2 2 A. The Order To Show Cause

In September 2014, the Department's Commissioner commenced an

administrative proceeding by filing an order to show cause alleging Boas

violated N.J.S.A. 17:33A-4(a)(1), which in pertinent part provides that a person

violates the New Jersey Insurance Fraud Protection Act (Act)1 by "[p]resent[ing]

or caus[ing] to be presented any written or oral statement as part of, or in support

of . . . a claim for payment or other benefit pursuant to an insurance policy . . .

knowing that the statement contains any false or misleading info rmation

concerning any fact or thing material to the claim."

The order to show cause alleged that from 2003 to 2007 Boas submitted

claims for insurance payments to Horizon for chiropractic services he did not

provide. More particularly, count one of the order to show cause alleged Boas

submitted claims for payment for 498 dates of service for patient A.O. 2 from

2003 through 2007 and received $28,962.40 in payments from Horizon, but A.O.

had only seen Boas a total of seven to fourteen times and had not seen Boas

since 2004. Count two alleged Boas submitted claims to Horizon for 531 dates

of service between June 2003 and January 2007 for patient A.O., Jr., and

1 N.J.S.A. 17:33A-1 to -30. 2 We identify the putative patients by use of initials to protect their privacy. A-2223-17T2 3 received $16,759 from Horizon, but Boas provided treatment to A.O., Jr., during

only two to three months in 2003. In count three, it was alleged Boas submitted

seventy-two claims to Horizon for dates of service between October 2005 and

July 2006 for E.M. and received $4650 in payments from Horizon, but Boas

only saw E.M. for an initial consultation and never saw E.M. again. Count four

alleged Boas submitted claims for providing services to E.M., Jr., on fifty-eight

separate dates and received $3013.12 from Horizon, but E.M., Jr., "had never

been treated by Boas."

The order to show cause set forth the statutory penalties and surcharge

that could be imposed for the alleged violations, and explained Boas was liable

for the Department's attorneys' fees and restitution of the sums he received from

Horizon for services he did not provide. The order to show cause further

explained that Boas had twenty days from his receipt of the order to show cause

to request a hearing and that, if he failed to do so, his right to a hearing would

be deemed waived and the allegations would be deemed admitted.

The Department served, and Boas received, the order to show cause in

September 2014. 3 The Department again served Boas with the order to show

3 The order was served on Boas by certified mail on September 26, 2014.

A-2223-17T2 4 cause in December 2014, 4 and at that time informed Boas that if he did not

respond within seven days, his right to a hearing would be deemed waived and

the Commissioner would dispose of the matter.

Boas failed to respond to the order to show cause. On November 16, 2015,

the Commissioner rendered a final agency decision, entering a detailed final

order finding Boas violated the Act by submitting at least 1011 fraudulent claims

for payment to Horizon for services he did not provide. The final order also

directed that Boas pay $500,000 in civil and administrative penalties pursuant

to N.J.S.A. 17:33A-5 and N.J.A.C. 11:16-7.6, a $1000 statutory insurance fraud

surcharge in accordance with N.J.S.A. 17:33A-5.1, $3459 in attorneys' fees

pursuant to N.J.S.A. 17:33A-5(c) and N.J.A.C. 11:16-7.9(c), and $53,384.52 in

restitution pursuant to N.J.S.A. 17:33A-5(c) and N.J.A.C. 11:16-7.9(c).

B. Boas's Motion To Vacate The Final Order

Four months later, in March 2016, Boas filed a motion to vacate the final

order. In support of the motion, Boas submitted a certification asserting that

upon his receipt of the order to show cause on September 26, 2014, he called the

attorney who represented him in the criminal proceeding, forwarded the order

to show cause to the attorney by telefax, and was assured by the attorney that he

4 The order was served on Boas by certified mail on December 14, 2014. A-2223-17T2 5 "would handle the matter." Boas also certified that he received the December

2014 "second notice" concerning the order to show cause and forwarded it by

telefax to the attorney. Boas annexed to his certification telefax transmission

receipts he claimed confirmed that he forwarded the order to show cause to the

attorney in September and December 2014.

Boas also certified that, "[o]ver time, [he] received assurances from [the

attorney] that [the administrative] matter would be handled." He said the

attorney "eventually requested an additional retainer" to represent Boas in the

matter and that he paid the attorney $2000 "to represent [him] on this matter and

a matter before the Board of Chiropractic Examiners." Boas annexed to his

certification a July 6, 2015 check in the amount of $2000 that is payable to the

attorney.

Boas further certified that when he learned of the November 2015 final

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