Five Individuals Sentenced in $1 Million Healthcare Fraud Case
Five Massachusetts residents and one New York resident have been sentenced in connection with a scheme to defraud various health insurance companies by submitting fabricated claims seeking reimbursement for over $1 million worth of bogus medical expenses, purportedly incurred during international travel.
Sentencing:
Brendon Ashe- Pleaded guilty to one count of conspiracy to commit health care fraud. Sentenced to two years’ probation and restitution in the amount of $145,683.
Aquiyla Atherton- Pleaded guilty to one count of conspiracy to commit healthcare fraud. Sentenced to five years’ probation, joint and several restitution of $376,000 with individual restitution in the amount of $96,000.
Darline Cobbler- Pleaded guilty to one count of conspiracy to commit health care fraud. Sentenced to two years’ probation and restitution in the amount of $73,817.
Henry Ezeonyido- Pleaded guilty to six charges of health care fraud and one count of conspiracy to commit health care fraud. Sentenced to 27 months in prison, to be followed by three of supervised release. Ordered to pay $655,313 in restitution and to forfeit $396,998 in criminal proceeds.
Ariel Lambert- Pleaded guilty to one count of conspiracy to commit healthcare fraud. Sentenced to two years’ probation, $85,550 restitution, and to forfeit $36,567.
Investigation:
Defendants submitted health insurance claims involving:
Expensive medical treatment that they purportedly received and paid for out-of-pocket while traveling overseas.
The claims submitted to four different insurance companies related to alleged traumatic injuries such as stabbings, hit-and-run car accidents, as well as gunshot wounds that the defendants purportedly suffered.
The complaint alleges that the defendants were in the United States when they claimed to be hospitalized in foreign countries. It is further alleged that some of the defendants received unrelated medical services in the United States at the same time they were purportedly hospitalized overseas.
In support of these claims submitted to the insurance companies, the defendants allegedly provided fabricated records – including fake bank records purporting to show payment to the treating facilities, bogus medical records purporting to show the medical care provided, and falsified police reports describing the circumstances of shootings or stabbings.
In some instances, the details of the claims submitted by or on behalf of the defendants and supporting documentation – including the dates of service, country where the alleged traumatic injuries occurred, and nature and circumstances of the alleged injuries are nearly identical to one another.
As a result of these fraudulent claims, various health insurance companies were billed over $1 million for services that were never rendered.
Outcome:
As a result of these fraudulent claims, the victim health insurance companies were billed over $1 million for services that were never provided, resulting in payments totaling approximately $655,313. Upon receiving these payments from their health insurance companies, Ashe, Cobbler, Lambert and others, paid a portion of the proceeds to Ezeonyido and other co-conspirators, including Atherton, who acted as an intermediary, bringing others into the scheme in exchange for a cut of their paid claims. In total, Ezeonyido retained approximately $396,998 in fraudulent proceeds.
United States Attorney Leah B. Foley; Kimberly Milka, Acting Special Agent in Charge of the Federal Bureau of Investigation, Boston Division; Ketty Larco-Ward, Inspector in Charge of the U.S. Postal Inspection Service’s Boston Division; and Anthony DiPaolo, Insurance Fraud Bureau Executive Director made the announcement today. Assistant U.S. Attorney Leslie A. Wright of the Health Care Fraud Unit prosecuted the case.
