Bill of Information for Felony Health Care Fraud — United States v. Erika James (Dkt. 1, filed 06/21/22)
Summary
A Bill of Information for felony health care fraud in United States of America v. Erika James, Case 2:22-cr-00123-SSV-DPC, U.S. District Court, Eastern District of Louisiana, Document 1, filed 06/21/22. In Count 1, citing Title 18, United States Code, Sections 1347, the United States Attorney charges that James, a Denial Specialist in the Billing Department of Crescent Care, took part in a scheme to defraud involving claims to the Louisiana Ryan White Part B Health Insurance Program. In the offense section, it alleges that James transmitted a claim for services that had not been performed and received a reimbursement check made out to the patient totaling $729.47. A notice of forfeiture cites Title 18, United States Code, Section 982(a)(7).
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“Bill of Information for Felony Health Care Fraud — United States v. Erika James (Dkt. 1, filed 06/21/22).”
Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/court-filing-no-2-22-cr-00123-dkt-1-b195c8c4c4/
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Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 1 of 6
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UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
BILL OF INFORMATION FOR
FELONY
HEALTH C FRAUD
UNITED STATES OF AMERICA {<
CRIMINAL NO.
22* 00 1 2g
v * SECTION:
*
SECT. RI}IAG.2
ERIKA JAMES YIOLATION: 18 U.S.C. $ 1347
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The United States Attorney charges that:
COUNT 1
A. AT ALL TIMES TERIAL HEREIN:
1. The Louisiana Department of Health Office of Public Health STD/HIV/Hepatitis
Program ("LDH OPH SHHP") is the Health Resources and Services Administration ("HRSA")
Ryan White Part B Program grantee for Louisiana.
2. Crescent Care ("CC") is a Federally Qualified Health Center ("FQHC") and AIDS
Service Organization ("ASO") that provides HIV medical care, and other health care as well as
social services in the New Orleans area.
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Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 2 of 6
3. CC participates in the Louisiana Health Access Program ("LAHAP"). LAHAP
receives federal funding. Within LAHAP, the Louisiana Ryan White Part B Health Insurance
Program ("HIP") serves as a provider of medical care and social services for HIV positive
individuals. HIP privately contracts with HIV Alliance for Region 2 ("HAART") to collect and
process claims.
4. HIP is a health care benefit program as defined by Title l8 U.S.C. $ 24(b), and, as
a health care benefit program, HIP affects commerce.
5. CC is also eligible to receive money from patients from Open Health Care Clinic,
which also uses HAART to process claims made to HIP.
6. Defendant ERIKA JAMES ("JAMES"), ofNew Orleans, Louisiana, was a Denial
Specialist in CC's Billing Department from April 2017 to April202l.
7. JAMES was responsible for both submitting claims to HIP via HAART, and for
receiving and accounting for claims checks received from HAART on behalf of HIP.
B. THE SCHEME AND CE TO DEFRAUD:
8. It was part of the scheme and artifice to defraud that JAMES unlawfully enriched
herself by, among other things: (a) submitting and causing the submission of false and fraudulent
claims to HIP via HAART; (b) concealing the submission of false and fraudulent claims to HIP
via HAART; (c) diverting proceeds of the fraud for personal use and benefit; and (d) depositing,
withdrawing, and transferring the proceeds of the fraud into her bank for personal use and benefit.
9. It was further part of the scheme and artifice to defraud that JAMES created
fraudulent invoices with falsified supporting documents, such as explanation of benefits ("EOB")
documents from insurance companies, for actual HIP clients.
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Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 3 of 6
10. It was further part of the scheme and artifice to defraud that JAMES endorsed
checks that were issued to patients that were in higher amounts than the usual range of the refund
amount.
I 1. It was further part of the scheme and artifice to defraud that JAMES made false
claims in the system that made it appear that patients came into CC and paid out of pocket for
services. As a result, HIP issued reimbursements to CC, making the patient eligible to receive a
refund check. JAMES would then have the Finance Department issue the patient refund check,
and JAMES would then deposit the refund check into her personal bank account.
12. It was further part ofthe scheme and artifice to defraud that JAMES filed additional
false claims with LAHAP to receive supplemental insurance payments to cover patient expenses
that are not covered by insurance. JAMES would fill out a claim form and use high paying service
codes, some services of which are not offered at CC, and submit the claim form to LAHAP for
reimbursement. The claim forms were sent from JAMES's CC email account.
13. It was further part of the scheme and artifice to defraud that JAMES emailed
LAHAP in December in2020 and told LAHAP to mail the checks to her residence. The checks
that were sent from LAHAP to JAMES's residence were made out to CC. JAMES then proceeded
to deposit those checks into her personal bank account.
14. It was further part of the scheme and artifice to defraud that JAMES, acting in her
capacity as a CC billing employee responsible for both submitting claims to HAART/HIP and for
receiving and accounting for claims checks received from HAART/FIIP, deposited 38 checks
produced by HAART based on claims received from CC totaling approximately 529,491.
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Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 4 of 6
D. THE OFFENSE:
On or about January 18,2021, within the Eastern District of Louisiana and elsewhere, the
defendant, ERIKA JAMES, knowingly and willfully executed the scheme to defraud a health
care benefit program in connection with the payment for health care services, to wit: JAMES
transmitted a claim for services that had not been performed, and subsequently received a
reimbursement check made out to the patient totaling $729.47, which she deposited in her personal
bank account.
All in violation of Title 1 8, United States Code, Sections 1347.
NOTICE OF FORFEITURE
1. The allegations of Count I of this Bill of Information are incorporated by reference
as though set forth fully herein for the pu{pose of alleging forfeiture to the United States.
2. As a result of the offense alleged in Count l, the defendant, ERIKA JAMES, shall
forfeit to the United States pursuant to Title 18, United States Code, Section 982(a)(7), any
property, real or personal, involved in said offense, which constitutes or is derived from proceeds
traceable to such offense.
3. If any of the property subject to forfeiture, as a result of any act or omission of the
defendant:
(a) cannot be located upon the exercise ofdue diligence;
(b) has been transferred or sold to, or deposited with, a third person;
(c) has been placed beyond the jurisdiction of the Court;
(d) has been substantially diminished in value; or
(e) has been commingled with other property which cannot be subdivided
without diffrculty;
4
Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 5 of 6
the United States shall seek a money judgment and, pursuant to Title 21, United States Code,
Section 853(p), forfeiture of any other property of the defendant up to the value of said property.
DUANE A. EVANS
LINITED STATES ATTORNEY
,.2/L
J. RYAN MgLAREN
Assistant United States Attorney
New Orleans, Louisiana
June2l,2022
5
Case 2:22-cr-00123-SSV-DPC Document 1 Filed 06/21/22 Page 6 of 6 a
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