SIXTEEN NEW YORK STATE EMPLOYEES CHARGED WITH STEALING NEARLY $400,000 BY FILING FRAUDULENT MEDICAL REIMBURSEMENT CLAIMS
Bronx District Attorney Robert T. Johnson announced today that sixteen New York State employees have been arrested and charged with grand larceny and other offenses for allegedly submitting numerous fraudulent medical claims to their insurance company.
Mr. Johnson said twelve people have been charged in the Bronx, while cases against four other State workers are being prosecuted by the Office of Manhattan District Attorney Robert Morgenthau because of jurisdictional issues. Mr. Johnson said investigators expect to make at least one additional arrest for prosecution in the Bronx.
These arrests are the result of a 6 month joint investigation by the Bronx District Attorney’s Office, the New York State Insurance Department, and the Office of the New York State Inspector General.
The defendants allegedly submitted claims totaling more than $600,000 for medical treatments that they never received. It is also alleged that they pocketed $389,423 which the insurance company paid on those fraudulent claims which were submitted between December 2002 and April 2005.
District Attorney Johnson said: “The crimes alleged in this case represent unconscionable greed at the expense of hard working, honest, consumers who are forced to pay higher insurance premiums in order to cover the legitimate medical expenses which they incur. Such behavior is unacceptable and must be punished appropriately.”
NYS Superintendent of Insurance Howard Mills said: “The individuals arrested in this sweep appear to have victimized a major health insurance company and their honest New York customers, by engaging in fraudulent activities that often lead to higher premiums. The Insurance Department’s Frauds Bureau is aggressive in its pursuit of those who cheat the system and we’ll continue to allocate the resources needed to investigate cases such as the one being announced today.”
State Inspector General Dineen Ann Riviezzo said: “The actions alleged in this case are especially troubling because the perpetrators not only defrauded the health care system, but they also violated the trust placed in them as public employees.”
The defendants were employed by either the Metro Developmental Disabilities Services Office of the New York State Office of Mental Retardation and Developmental Disabilities, or by The Research Foundation of the State University of New York. The workers are covered under The Empire Plan, New York State Government Employees Health Insurance Program.
Charges filed against the accused include Grand larceny in the 2nd and 3rd degrees, Insurance Fraud in the 2nd and 3rd degrees, Criminal possession of a forged instrument in the 2nd degree, Criminal possession of stolen property in the 3rd degree and Falsifying business records in the 1st degree. The bulk of the charges are Class D and Class E felony offenses punishable by maximum sentences of up to 7 years and 4 years imprisonment respectively. The most serious charges, Class C felony offenses which have been filed against two of the defendants, are punishable by a maximum sentence of up to 15 years imprisonment.
The insurance company uncovered the scam because of a clerical mistake on one of the claim forms. When the insurance company contacted the doctor to explain that the claim was being rejected because the wrong code was entered for the particular treatment rendered, the doctor told the company that the person who had submitted the claim was not one of her patients. That in turn triggered further investigation including an internal audit that brought to light the scope of the scam.
Following are the defendants who are being prosecuted in the Bronx:
| Nicole Garrett, 29, of 765 East 165th Street, the Bronx |
| Karen Gordon, 37, of 671 Manida Street, the Bronx |
| Stephen Hymon, 35, of 825 Morrison Avenue, the Bronx |
| Barbara Lee, 59, of 1561 Metropolitan Avenue, the Bronx |
| Kimberly Miles, 36, of 80 West 170th Street, the Bronx |
| Milagros Morales, 42, of 1160 Cromwell Avenue, the Bronx |
| Mirgre Ortiz, 36, of 1805 Gleason Avenue, the Bronx |
| Diana Vasquez, 49, of 400 Benson Street, the Bronx |
| Elliot Vasquez, 62, of 400 Benson Street, the Bronx |
| Angela Whitaker, 42, of 3478 Corsa Avenue, the Bronx |
| Gwendolyn Wilder, 27, of 615 East 168th Street, the Bronx |
| Steven Zimmerman, 38, of 840 Grand Concourse, the Bronx |
Following are the defendants who are being prosecuted in Manhattan:
| Jeanine Crawford, 30, of 216 West 141st Street, New York, N.Y. |
| Ebony King, 26, of 229 West 144th Street, New York, N.Y. |
| Roberta Leftenant, 50, of 229 West 144th Street, New York, N.Y. |
| Georgette Pleasant, 53, of 2569 7th Avenue, New York, N.Y. |
District Attorney Johnson thanked the following for their hard work on this investigation:
Office of the New York State Inspector General; the New York State Insurance Department Fraud Bureau and Bureau Investigators Doug Libertucci and Joe Edwards; Detective Investigator Bradford Waterman, Bronx District Attorney’s Office; Detective Investigator Judith Newton, New York County District Attorney’s Office.
Assistant District Attorney Duncan Levin is prosecuting the four defendants charged in New York County.
Assistant District Attorney Erik Hassing and Assistant District Attorney Brian Reese are prosecuting the twelve defendants charged in the Bronx.
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