Attorney General Jennifer Davenport and the Office of the Insurance Fraud Prosecutor (OIFP) announced today that an East Orange, New Jersey, man has been sentenced to three years in New Jersey state prison for filing thousands of false Medicaid claims and receiving approximately $3.48 million in fraudulent payments from the program through a company he took over from his deceased sister.

Vicente Lopez, 64, pleaded guilty in June 2026 before Superior Court Judge L. Grace Spencer to health care claims fraud, Medicaid fraud, and three counts of filing a fraudulent tax return. In addition to the prison term, Lopez was ordered to pay $95,000 in restitution to the state. Judge Spencer imposed the sentence October 21, 2026, in Essex County.

“Medicaid is intended to provide critical health care to vulnerable New Jersey residents who need it, not to serve as a source of personal profit through fraudulent billing,” said Attorney General Davenport. “Individuals and families in New Jersey count on this health care lifeline. This sentence demonstrates that those who exploit this vital program for their own financial gain will be held accountable.”

“For years, the defendant submitted or directed the submission of thousands of false claims for services he was neither qualified nor authorized to provide,” said Acting Insurance Fraud Prosecutor Bernard J. Cooney. “His scheme resulted in millions of dollars in improper Medicaid payments, and today’s sentence holds him responsible for that conduct.”

According to documents filed in this case and statements made in court, Lopez was the head of Joyce Lopez & Associates (JLA), which at one time provided psychological counseling services to Medicaid patients. After his sister died in 2021, Lopez took sole control of JLA.

Lopez submitted or caused to be submitted over 34,000 claims to Medicaid for psychological services and received approximately $3.48 million in connection with those claims. Neither Lopez nor JLA was an approved Medicaid provider. Lopez submitted the false claims using the name and provider number of a licensed psychiatrist without the psychiatrist's permission or knowledge. The psychiatrist also did not provide psychotherapy services to any JLA patients. Lopez also impermissibly billed Medicaid for services not rendered.

Lopez failed to pay taxes for tax years 2021, 2022, and 2023. When brought to his attention by the State, Lopez eventually filed his tax returns but failed to disclose his full income. As of June 18, 2025, Lopez had a personal net New Jersey state tax liability of $52,372 for tax years 2021-2023. As of that date, he also owed a combined civil fraud penalty to the State of New Jersey totaling $26,186, with an additional $21,151 in interest, totaling $99,709 in taxes, penalties, and interest.

The case is being prosecuted by Deputy Attorney General Laura L. Bryant of OIFP’s Medicaid Fraud Control Unit (MFCU). The case was investigated by Sergeant Michael Rosati. Acting Insurance Fraud Prosecutor Cooney also thanked the New Jersey Department of the Treasury’s Office of Criminal Investigation for its assistance.

OIFP’s Medicaid Fraud Control Unit specifically protects Medicaid beneficiaries and the Medicaid Program from fraud, waste, and abuse. The Unit also may review complaints of abuse or neglect of patients or residents in care facilities regardless of the funding source.

New Jersey MFCU’s total funding for federal fiscal year 2026 is $11.6 million. Of that total, 75 percent is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent is funded by the State of New Jersey.

To report fraud, abuse or neglect, please email NJMFCU@njdcj.org or call 609-292-1272. If you are concerned about insurance cheating in general, and have information about insurance fraud, you can report fraud anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting www.NJInsurancefraud.org. State regulations permit a reward to be paid to eligible persons who provide information that leads to an arrest, prosecution, and conviction for insurance fraud.

Defense counsel:
Lisa Sullivan Lopata, Esq., Assistant Deputy Public Defender