Our view: NJ alleges old-style health-benefits fraud in Wildwood | Latest Headlines
Health Style

Our view: NJ alleges old-style health-benefits fraud in Wildwood | Latest Headlines

When we saw the words “health benefits fraud” in a headline recently, our first thought was finally, a step toward justice in the massive kickbacks to public employees in South Jersey for submitting bogus prescriptions to their lavishly funded state health plan.

A federal investigation detailed at least $50 million in fraudulent claims, starting in 2015. Of the 200 involved — including school employees, firefighters and other government workers — many have been convicted but fewer sentenced. The public is rightly worried after so many years that one part of government may be going easy on lawbreakers in another part who greedily betrayed the generosity of taxpayers. State and federal authorities should give the public an update in the case as soon as possible.

The headline late last month instead announced new accusations in Wildwood. Marc Pfeiffer of the Bloustein Local Government Research Center at Rutgers University has said the generosity of New Jersey’s $3 billion State Health Benefits Plan offers opportunities for fraud. Three city officials allegedly availed themselves of a familiar old form.

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Mayor Pete Bryon, former Mayor Ernest V. Troiano Jr. and current city Commissioner Steven E. Mikulski were charged with fraudulently getting government worker health coverage for jobs that were less than full time.

Acting Attorney General Matthew J. Platkin said each was charged with theft by unlawful taking (from the State Health Benefits Program) and tampering with public records information (for attempts to make it look like they worked full time).

Platkin said the alleged actions to get unwarranted paid health coverage were “breaches of the public trust” and he pledged, ““We will work tirelessly to root out public corruption and restore faith in our institutions.”

A little more than a decade ago, getting underserved health coverage cheated the paying public, but it wasn’t against state law. Until then it was common and up to municipalities to put an end to the practice by their officials.

In 2009, Ocean City Mayor Sal Perillo was attacked for proposing to eliminate health-insurance benefits for City Council members, who worked part-time. He figured the city and taxpayers would save $150,000 a year.

Absecon and Port Republic had never offered health benefits to their part-time elected officials. Galloway Township Council members started the next year right by voting unanimously to eliminate their own health benefits

Pressure built on state legislators, who were also part-time employees receiving health coverage. That same year, 2010, New Jersey enacted a law requiring elected officials to be full-time employees “whose hours of work are fixed at 35 or more per week” to be eligible for the State Health Benefits Program and employer-provided health care.

In Wildwood, the investigation found Byron, Troiano and Mikulski were never full-time employees as defined by state law. They did not receive vacation, sick or personal days, and they maintained no regular schedule.

Platkin said Troiano and Byron falsely signed and submitted timesheets to the city indicating they worked full days Monday through Friday. As a result, Wildwood and the state plan paid more than $286,500 in premiums and claims on behalf of Troiano from July 2011 through December 2019. For Byron, the state plan paid more than $608,900 in premiums and claims on his behalf from July 2011 through 2021.

That’s a lot of money and we’re glad to see the Attorney General’s Office pursuing the case.

But the numbers are small compared to the tens of millions taken with fraudulent prescriptions mainly for compounded medicines by corrupt benefits managers, doctors and dozens of regular government workers supposedly serving the public, not stealing from it. We share the widespread interest in making sure that case is pursued to its just end as well.