NEW ORLEANS – The U.S. Attorney’s Office for the Eastern District of Louisiana, announced that, ERIKA JAMES (“JAMES”), age 48, a resident of New Orleans, Louisiana, was charged on June 21, 2022 with one count of health care fraud.
According to the bill of information, JAMES was a Denial Specialist at Crescent Care, a Federally Qualified Health Center and AIDS Service Organization. Crescent Care provides HIV medical care, other health care, and social services in the New Orleans area.
From March 2020 through April 2021, JAMES created fraudulent invoices with falsified supporting documents, such as explanation of benefits documents from insurance companies. JAMES endorsed checks that were issued to patients that were 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 JAMES 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 Crescent Care. JAMES then proceeded to deposit those checks into her personal bank account.
If convicted, 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.
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