Erika James, Healthcare Fraud, Louisiana 2022

New Orleans woman, Erika James, 49, has pleaded guilty to one count of healthcare fraud, a serious crime committed in the city of New Orleans, Louisiana.

The U.S. Attorney’s Office for the Eastern District of Louisiana announced on an unspecified date that Erika James had pleaded guilty to one count of healthcare fraud on October 4, 2022. According to court documents, James was a Denial Specialist at Company 1, a Federally Qualified Health Center and AIDS Service Organization.

Between March 2020 and April 2021, James created fraudulent invoices with falsified supporting documents, such as explanation of benefits documents from insurance companies. She also 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 Company 1 and paid out of pocket for services. She would have the Finance Department issue the patient refund check, and would then deposit the refund check into her personal bank account.

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 Company 1. James then proceeded to deposit those checks 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. Judge Sarah S. Vance set the sentencing hearing for January 25, 2023.

The U.S. Attorney Evans praised the work of the United States Department of Health and Human Services – Office of Inspector General. Assistant U.S. Attorneys J. Ryan McLaren and Kathryn McHugh are in charge of the prosecution.

Erika James will appear before Judge Sarah S. Vance for sentencing on January 25, 2023. The case serves as a reminder of the importance of transparency and accountability in healthcare.

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