Prosecutor Improperly Relied on Insurer’s Fraud Investigator’s Inadequate Investigation to Indict Physician and Assistant

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New Jersey State insurance law requires insurers to maintain a Special Investigative Unit (SIU) to investigate and report insurance fraud to the state. After the report is made the state must conduct its own investigation to determine if a prosecutable fraud occurred.

In State Of New Jersey v. Yvonne Jeannotte-Rodriguez, Marta I. Gal Van, Lisa Ferraro, Nos. A-4361-19, A-4371-19, A-4374-19, Superior Court of New Jersey, Appellate Division (August 25, 2021) The New Jersey Appellate Division was faced with three appeals, after the State contended the trial court wrongly dismissed (without prejudice) a six-count indictment against Lisa Ferraro, M.D., Yvonne Jeannotte-Rodriguez, and Marta Galvan. 

ZALMA OPINION

SIU investigators are insurance people not police officers nor are the investigators working for prosecutors. They are required by statute to advise the state that fraud is suspected. The state is obligated, before seeking an indictment, to gather evidence that supports a criminal charge. The state of New Jersey relied upon Mr. Menendez, an insurance investigator, whose inferences indicated fraud but failed to provide the grand jury with actual evidence. Although it is often true that a grand jury will indict a ham sandwich no court will allow trial to go forward against the sandwich and that is why this indictment failed.