Louisiana Woman Pleads Guilty to Healthcare Fraud in Connection with Generating False Invoices

Louisiana – On October 11, 2022, the U.S. Attorney’s Office for the Eastern District of Louisiana, announced that Erika James (“James”), age 49, from New Orleans, Louisiana, pleaded guilty to one count of health care fraud on October 4, 2022.

James worked as a Denial Specialist at Company 1, a Federally Qualified Health Center and AIDS Service Organization, according to court records. From March 2020 through April 2021, James generated false invoices with forged supporting documentation, such as insurance company explanation of benefits paperwork. James authorized checks issued to patients in amounts more than the customary range of the return amount. James entered claims into the system that made it look that patients came into Company 1 and paid for services out of pocket. James would have the Finance Department issue the patient a refund check, which he would deposit into her personal bank account.

In December 2020, James filed more claims with the Louisiana Health Access Program (“LAHAP”) and instructed LAHAP to mail the checks to her address. The checks mailed to James’s house were made payable to Company 1. James then deposited the checks into her personal bank account.

James faces a maximum term of ten years in prison, three years of supervised release, a $250,000 fine, and a $100 special assessment charge. The sentencing hearing has been scheduled on January 25, 2023, by Judge Sarah S. Vance.

US Attorney Evans lauded the work of the Office of Inspector General of the US Department of Health and Human Services. The prosecution is led by Assistant United States Attorneys J. Ryan McLaren and Kathryn McHugh.