Indictment outlines multimillion-dollar health care fraud case in Middle Georgia
Prosecutors say the case involves fraudulent therapy claims submitted to major insurance providers
MONTEZUMA, Georgia (41NBC/WMGT)- Five people have been charged in a federal health care fraud case in Middle Georgia, according to an indictment filed in the U.S. District Court for the Middle District of Georgia.
The indictment names Dawn James-Ellis, Lamonica Lakes, Tarshea Fudge-Riley, Angela Childs, and Adrian Harris as defendants.
According to the indictment, the defendants are charged with conspiracy to commit health care fraud. The indictment also charges James-Ellis with identity theft.
Federal prosecutors say the case involves the submission of fraudulent claims for mental health therapy services to health care benefit programs, including Blue Cross Blue Shield, Aetna, Cigna, and Optum.
How the scheme is described
The indictment says the conduct described in the case occurred from as early as January 2019 through December 2022.
According to the indictment, James-Ellis, a licensed therapist who operated “Therapy On the Go” in Montezuma, directed others to create therapy session notes for services that did not occur.
Prosecutors say those notes were then used to support insurance claims submitted for reimbursement.
The indictment says claims were submitted for therapy sessions that did not occur and, in some instances, for more than 24 hours of services in a single day.
According to the indictment, claims were also submitted for sessions listed on weekends, holidays, and times when the therapist was away on vacation.
The indictment states some individuals were paid to provide their insurance information, while in other cases, that information was used without their knowledge.
According to the indictment, health care benefit programs were billed for and made payments totaling millions of dollars for services prosecutors say were not provided.
The indictment includes a forfeiture notice stating that, if convicted, the defendants could be required to forfeit property tied to the proceeds of the offenses.
Arrest warrants for the five were also issued. According to court records, the indictment was made public today.
