New Jersey Manufacturers Insurance Company

WEST TRENTON, N.J. — A northern New Jersey chiropractor has agreed to the entry of a $1 million insurance fraud judgment in favor of New Jersey Manufacturers Insurance Group because he submitted bills for nerve conduction tests that violated the law. The bills were illegal, in part, because they did not disclose that the nerve conduction tests were administered by office technicians, including a 15-year-old boy, in violation of state regulations.

NJM Insurance Group sued Dr. Sean Nisivoccia in 2005 for fraudulent Nerve Conduction Velocity (NCV) tests allegedly conducted at his chiropractic offices in East Orange, N.J., and Clifton, N.J., on more than 60 individuals involved in auto accident claims from 1999 through late 2004. As part of the settlement, Nisivoccia has agreed not to challenge a judge's ruling in 2006 that submitting those bills violated the New Jersey Insurance Fraud Prevention Act.

In order to administer NCV tests, which are used to ascertain whether nerve damage has occurred, a state regulation requires a chiropractor to undergo formal training and obtain a certificate of competency. Records from the New Jersey Board of Chiropractic Examiners indicated that Nisivoccia did not earn an NCV certificate until December 2004, despite having submitted bills for NCV tests since 1999.

Even if Nisivoccia had been certified, regulations require the doctor, not a technician, to conduct the tests. NJM's Special Investigations Unit (SIU) found out that Nisivoccia ordered the tests to be conducted by so-called technicians, one of whom was the 15-year-old boy. This discovery spurred an in-depth review by NJM of all relevant patient files.

NJM Insurance Group's lawsuit argued that, because the tests themselves were illegal, all treatment expenses allegedly justified by the tests were fraudulently billed in violation of the New Jersey Insurance Fraud Prevention Act and should be recovered. NJM's suit named another chiropractor and three doctors who allegedly referred patients to Nisivoccia for the illegal testing. NJM has provided evidence it obtained with regard to the Nisivoccia case to the appropriate medical boards and the Office of the Insurance Fraud Prosecutor for further consideration.

"The Nisivoccia settlement will recover valuable funds for our policyholders, and is a great accomplishment for our SIU," said Anthony G. Dickson, President and CEO of NJM Insurance Group. "But medical fraud involves more than just money. While most medical practitioners have the utmost concern for the well-being of their patients, dishonest doctors may take risks that can endanger their patients. Doctors who are proven to be dishonest should lose their licenses, be prosecuted to the fullest extent of the law, and be sent to jail."

New Jersey Manufacturers Insurance Company operates exclusively for the benefit of policyholders. Through prudent underwriting and careful stewardship, NJM has returned more than $4.2 billion in dividends to policyholders since 1918. NJM has long been the Garden State's largest provider of Workers' Compensation and a leading writer of Personal Auto, Commercial Auto and residential coverage.

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