Insurance Fraud NEWS

Coalition Against Insurance Fraud

Office manager allegedly files fake surgery claims in New York

March 28, 2019, Suffolk County, NY — Suffolk County District Attorney Timothy D. Sini today announced the unsealing of a 70-count indictment against a former health care worker for allegedly fraudulently receiving more than $400,000 through a health care insurance fraud scheme.

“This was an act of pure greed,” District Attorney Sini said. “He used his knowledge of the health care insurance system to illegally pocket hundreds of thousands of dollars, money that would have otherwise been used to care for people who were sick and in need. Our office will continue to work with our partners in law enforcement and in the private sector to investigate and prosecute financial crimes.”

Joseph Basile, 50, of East Setauket, is charged with Insurance Fraud in the First Degree, a B felony; three counts of Healthcare Fraud in the Second Degree, a C felony; two counts of Grand Larceny in the Second Degree, a C felony; Healthcare Fraud in the Third Degree, a D felony; Grand Larceny in the Third Degree, a D felony; Scheme to Defraud in the First Degree, an E felony; and 60 counts of Criminal Possession of a Forged Instrument in the Second Degree, a D felony.

Basile was previously employed as an office manager for a private health care practice by a colorectal surgeon in Port Jefferson before the practice closed in 2013. The owner is currently employed by John T. Mather Hospital in an administrative role and is no longer seeing patients on a clinical basis.

From January 2014 through July 2016, Basile allegedly fraudulently filed insurance claims to Empire BlueCross BlueShield in excess of $3.8 million on behalf of himself and others listing his former employer as the provider. The claims were for medical procedures, including colorectal surgeries, that had not actually been performed.

Basile then allegedly forged the signature of his former employer and deposited the checks into his own account.

In total, Basile allegedly received more than $400,000 in fraudulent payments, paid for by both Empire BlueCross BlueShield and John T. Mather Hospital.

As part of the scheme, Basile also allegedly filed fraudulent insurance claims on behalf of another individual whose health care is provided through Teamsters Local 1205’s welfare fund. Basile allegedly stole more than $3,000 from the fund by filing false health care insurance claims.

Basile was arraigned on the indictment today by Suffolk County Court Judge Anthony Senft Jr. and was released on $5,000 bond, which he previously posted. He is due back in court on March 12.

If convicted of the top count, Basile faces a maximum sentence of eight and one-third to 25 years in prison.

This case is being prosecuted by Assistant District Attorney Shiry Gaash, of the Financial Investigations and Money Laundering Bureau.

A criminal charge is merely an accusation and the defendant is presumed innocent until and unless proven guilty.

Source: SmithTown

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