Erika James, Health Care Fraud, Louisiana 2022

New Orleans Woman Charged with Health Care Fraud Charged with Stealing Over $100,000 from Crescent Care

The U.S. Attorney’s Office for the Eastern District of Louisiana announced that Erika James, a 48-year-old resident of New Orleans, has been charged with one count of health care fraud. The charge stems from an investigation into her actions as a Denial Specialist at Crescent Care, a Federally Qualified Health Center and AIDS Service Organization.

According to the bill of information, James created fraudulent invoices with falsified supporting documents, including explanation of benefits documents from insurance companies. She then endorsed checks that were issued to patients in higher amounts than the usual range of the refund amount. James made claims in the system that made it appear that patients came into Crescent Care and paid out of pocket for services.

James would then have the Finance Department issue the patient refund check, and she would deposit the refund check into her personal bank account. In addition, James filed additional claims with the Louisiana Health Access Program (LAHAP) in December 2020 and told LAHAP to mail the checks to her residence. The checks that were sent to James’s residence were made out to Crescent Care, which she then deposited into her personal bank account.

James faces a possible maximum sentence of ten years’ imprisonment, up to three years of supervised release, up to a $250,000 fine, and a mandatory $100 special assessment fee per count. The United States Attorney’s Office, Eastern District of Louisiana stated that the bill of information is merely a charge and that the guilt of the defendants must be proven beyond a reasonable doubt.

The case is being investigated by the United States Department of Health and Human Services – Office of Inspector General. The prosecution of the case is being handled by Assistant U.S. Attorneys J. Ryan McLaren and Kathryn McHugh.

James’s actions were a brazen attempt to steal over $100,000 from Crescent Care. As a Denial Specialist, she had access to sensitive information and used that access to commit the crime. If convicted, James will face the consequences of her actions and the full weight of the law.

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