A woman who worked as a denial specialist for a New Orleans healthcare organization is facing a federal healthcare fraud charge.
Erika James, 48, was a denial specialist at CrescentCare, which provides HIV medical care, other healthcare and social services. The U.S. Justice Department alleged June 23 that between March 2020 and April 2021, Ms. James created fraudulent invoices with falsified supporting documents, such as explanation of benefits documents from insurance companies.
Ms. James allegedly 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, according to the department. She would have the finance department issue the patient refund check then deposit the check into her personal bank account, the department stated.
Ms. James allegedly filed additional claims with the Louisiana Health Access Program in December 2020 and told the program to mail the checks to her residence. The checks, which were made out to CrescentCare, were deposited into her personal bank account.
If convicted, Ms. James faces up to 10 years in prison and a fine up to $250,000.