A woman who worked as a denial specialist at New Orleans healthcare organization has pleaded guilty to a billing fraud scheme.
Erika James, 49, pleaded guilty to a federal healthcare fraud charge Oct. 4, according to an Oct. 11 Justice Department news release. Ms. James worked at CrescentCare, which provides HIV medical care, other healthcare and social services. According to the Justice Department, between March 2020 and April 2021, Ms. James created fraudulent invoices with falsified supporting documents.
Ms. James endorsed checks that were issued to patients that were in higher amounts than the usual refund amount range, according to the Justice Department. She made claims in the system that made it appear that patients came into CrescentCare and paid out of pocket for services. She would have the finance department issue the patient refund check then deposit the check into her personal bank account.
She filed additional claims with the Louisiana Health Access Program in December 2020 and told the program to mail the checks to her residence, according to the Justice Department. The checks, which were made out to CrescentCare, were deposited into her personal bank account.
Ms. James faces a maximum of 10 years in prison and up to a $250,000 fine. She is scheduled to be sentenced Jan. 25.