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NEW ORLEANS – 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.

According to court documents, JAMES was a Denial Specialist at Company 1, a Federally Qualified Health Center and AIDS Service Organization. From March 2020 through April 2021, JAMES created fraudulent invoices with falsified supporting documents, such as explanation of benefits documents from insurance companies. JAMES endorsed checks that were issued to patients that were in higher amounts than the usual range of the refund amount. JAMES made claims in the system that made it appear that patients came into Company 1 and paid out of pocket for services. JAMES would have the Finance Department issue the patient refund check, and would then deposit the refund check into her personal bank account.

JAMES filed additional claims with the Louisiana Health Access Program (“LAHAP”) in December 2020 and told LAHAP to mail the checks to her residence. The checks that were sent to JAMES’s residence were made out to Company 1. JAMES then proceeded to deposit those checks into her personal bank account.

JAMES faces a possible maximum sentence of ten years’ imprisonment, up to three years of supervised release, up to a $250,000 fine, and a mandatory $100 special assessment fee. Judge Sarah S. Vance set the sentencing hearing for January 25, 2023.

U.S. Attorney Evans praised the work of the United States Department of Health and Human Services – Office of Inspector General. Assistant U.S. Attorneys J. Ryan McLaren and Kathryn McHugh are in charge of the prosecution.