16 arrests in med scam

It is unfortunate that my co-workers are involved with this case.

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Say state workers stole 400G

By CHRISENA COLEMAN
DAILY NEWS STAFF WRITER

Sixteen state employees were facing some hard jail time yesterday after being criminally charged with submitting fraudulent medical reimbursement claims for nearly $400,000.
According to the Bronx district attorney's office, the state workers submitted $600,000 in claims for medical treatments they never received, and the insurance company paid $389,423 on claims submitted between December 2002 and April 2005.
The workers were charged this week with grand larceny, insurance fraud, criminal possession of a forged instrument, criminal possession of stolen property and falsifying business records.
If convicted, each faces up to 15 years in jail.
The insurance scam was uncovered because of a clerical mistake on one of the forms, prosecutors said.
When the insurance company contacted a doctor to explain that the claim was being rejected because the wrong code was entered for a treatment, the doctor realized the person who had submitted the claim was not a patient. Upon further investigation and an internal audit, the scam was uncovered.
Twelve of the 16 state workers were charged in the Bronx, while the other four were charged in Manhattan.
The 12 defendants from the Bronx are: Nicole Garrett, 29; Karen Gordon, 37; Stephen Hymon, 35; Barbara Lee, 59; Kimberly Miles, 36; Milagros Morales, 42; Migre Ortiz, 36; Diana Vasquez, 49; Elliot Vasquez, 62; Angela Whitaker, 42, Gwendolyn Wilder, 27 and Steven Zimmerman, 38. The other four, all of Manhattan, are: Jeanine Crawford, 30; Ebony King, 26; Roberta Leftenant, 50 and George Pleasant, 53. They will be prosecuted in Manhattan.
They were employed by either the Metro Developmental Disabilities Services Office of Mental Retardation or the Research Foundation of the State University of New York. The workers are covered under the Empire Plan, New York State Government Employees Health Insurance Plan.
"The crimes alleged in this case represent unconscionable greed at the expense of hard-working, honest consumers," said Bronx District Attorney Robert Johnson. "They are forced to pay higher insurance premiums in order to cover the legitimate medical expenses which they incur. This behavior is unacceptable and must be punished appropriately."
The arrests were the result of a six-month joint investigation by the Bronx district attorney's office, New York State Insurance Department and the Office of the New York State Insurance Department.
New York State Superintendent of Insurance Howard Mills said the defendants have "victimized a major health insurance company." He said the probe will continue. Originally published on July 21, 2005