Unlicensed Former Doctor and Husband from Ocean County Allegedly Reap More than $172,000 by Submitting Phony Bills to Patients’ Insurer

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TRENTON – Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor (OIFP) announced that an unlicensed former doctor and her husband were indicted today for billing a medical insurance company more than $172,000 for treatments that were not rendered to patients.

Lynda Stambaugh-Lupo, 52, and Michael Lupo, 61, both of Jackson, were charged by the state grand jury with second-degree conspiracy, second-degree health care claims fraud and second-degree theft by deception. Stambaugh-Lupo was also charged with third-degree practice of medicine by an unlicensed person.

OIFP is alleging that during the years 2012 through 2014, Stambaugh-Lupo, a former Doctor of Osteopathy, and her husband billed Anthem Blue Cross and Blue Shield approximately $172,626 for lymphatic therapy on two patients that Stambaugh-Lupo had not actually performed. The couple allegedly billed her lymphatic therapy services through their company In Home Lymphatic Care, LLC, for which Michael was office manager and signee on the allegedly fraudulent claims.

It further alleged that Stambaugh-Lupo, who surrendered her New Jersey Medical License in 1996 as a result of her arrest for obtaining a controlled dangerous substance by fraud, also represented to another patient and the patient’s medical insurer that she was a medical doctor.  These representations were allegedly made over the phone or directly to the patient at her home and to the insurer in letters in 2010 and 2011 that laid out the suggested course of treatment for the patient.

“The defendants have allegedly perpetrated a theft worth tens of thousands of dollars by lying to medical insurers,” said Acting Attorney General Hoffman. “Our charges show a clear pattern of deceitful behavior by this couple, exemplified by Stambaugh-Lupo’s misrepresentations that she was a licensed doctor.”

“We are working tireless to root out this type of fraud because every fraudulent dollar paid out to unscrupulous medical providers is essentially later billed directly to the public at large via insurance premiums,” said Acting Insurance Fraud Prosecutor Ronald Chillemi. “Aggressive prosecution is both a successful deterrent and a stabilizing force for premiums.”

The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of up to $150,000, while third-degree crimes carry a maximum sentence of five years in prison and a fine of up to $15,000.

Deputy Attorney General Thomas Tresansky presented the case to the grand jury. Detectives Kristi L. Procaccino and Megan Flanagan led the investigation and were assisted by Analysts Terri Drumm and Marie Beyer.

Acting Insurance Fraud Prosecutor Chillemi noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting the Web site at www.NJInsurancefraud.org. State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.