East Orange Man Indicted for $3.4M Medicaid Fraud Scheme Using Sister’s Counseling Business

Vicente Lopez allegedly submitted over 34,000 false claims through a defunct psychological services firm and evaded nearly $100K in state taxes

An Essex County man has been indicted for allegedly orchestrating a massive Medicaid fraud scheme that generated more than $3.4 million in illegal reimbursements through thousands of false claims, New Jersey Attorney General Matthew J. Platkin announced.

Vicente Lopez, 63, of East Orange, was indicted by a state grand jury on September 3, 2025, on multiple charges, including:

• Health care claims fraud (2nd degree)

• Theft by deception (2nd degree)

• Medicaid fraud (3rd degree)

• Three counts each of failure to pay tax and filing fraudulent returns (3rd degree)

“Medicaid is a vital lifeline, providing needed health care coverage to low-income individuals and families,” said Attorney General Platkin. “Health care is expensive, and resources are finite, so it is especially troubling whenever someone chooses to steal from this important public program. This defendant is charged with defrauding the system of millions of dollars to which he was in no way entitled.”

According to court documents, Lopez is the head of Joyce Lopez & Associates (JLA), a psychological counseling company previously run by his late sister, Joyce Lopez, who died in 2021. Following her death, Vicente Lopez allegedly took over JLA and continued to bill Medicaid for psychological services, even though neither he nor the company were registered as authorized Medicaid providers.

Over the course of the scheme, Lopez and his employees allegedly submitted more than 34,000 false Medicaid claims, using the provider number and identity of a licensed psychiatrist, referred to in court documents as “TF”—without that individual’s knowledge or consent. Investigators found that TF never treated a single patient at JLA.

Further fraudulent activity allegedly included billing Medicaid:

• When patients canceled or missed appointments

• For psychological services when only case management was provided

“Not only is the defendant charged with brazenly submitting 34,000 claims for services never provided, he also allegedly hid his income and failed to pay taxes,” said DCJ Director Theresa L. Hilton. “The indictment alleges that Lopez is neither qualified nor authorized to provide the services for which he was reimbursed by Medicaid."

In addition to the Medicaid fraud charges, Lopez is also accused of failing to file accurate state tax returns for tax years 2021 through 2023. He allegedly underreported income even after being contacted by the State of New Jersey. As of June 18, 2025, Lopez owed the state a total of $99,709 in back taxes, penalties, and interest:

• $52,372 in unpaid taxes

• $26,186 in civil fraud penalties

• $21,151 in interest

Penalties

• Second-degree charges carry a sentence of 5 to 10 years in state prison and a fine of up to $150,000.

• Third-degree charges carry 3 to 5 years in prison and a fine of up to $15,000.

“Insurance fraud – especially when it targets publicly funded programs – is a crime that victimizes all of us,” said Interim Insurance Fraud Prosecutor Al Garcia. “It diverts limited public money from the people for whom it is intended. This kind of criminal activity will not be tolerated by my office.”

This case is being prosecuted by the Office of the Insurance Fraud Prosecutor (OIFP) – Medicaid Fraud Control Unit (MFCU), led by Deputy Attorneys General Laura L. Bryant and Simret Michael, under the supervision of Assistant Bureau Chief Michael Klein and Bureau Chief Heather Hadley.

The investigation was conducted by Sergeant Michael Rosati, under Lieutenant Joseph Jaruszewski and Deputy Chief Rich King. The New Jersey Division of Taxation, Office of Criminal Investigations also assisted in the case.

The charges remain allegations, and Lopez is presumed innocent unless and until proven guilty in a court of law.

Medicaid Fraud Reporting

Suspected Medicaid fraud or elder abuse can be reported to the Medicaid Fraud Control Unit via:

• Phone: (609) 292-1272

• Email: NJMFCU@njdcj.org

• Online: Medicaid Fraud or Elder Abuse Reporting Form

The New Jersey Medicaid Fraud Control Unit (MFCU) operates with a $12.63 million annual budget for fiscal year 2025, with 75% funded by the U.S. Department of Health and Human Services and 25% by the State of New Jersey. The unit investigates and prosecutes Medicaid fraud as well as abuse and neglect of patients in healthcare facilities.