NYC Medicaid Reimumbursement Unit Employee Guilty of Million Dollar Medicaid Fraud 2

NYC Medicaid Reimumbursement Unit Employee Guilty of Million Dollar Medicaid Fraud

Preet Bharara, United States Attorney for the Southern District of New York, announced today that AKIM MURRAY, an employee of the Medicaid Reimbursement Unit of the New York City Human Resources Administration (“HRA”), pled guilty before U.S. District Judge Richard M. Berman to a Medicaid fraud scheme in which MURRAY, whose job involved issuing reimbursements for Medicaid-eligible expenses, manipulated the system in order to have over one million dollars’ worth of checks issued to his friends and criminal associates. Those co-conspirators, in turn, gave MURRAY a substantial cut of the proceeds.

Manhattan U.S. Attorney Bharara said: “For over a year, Akim Murray used his job within New York City government to essentially embezzle funds intended to benefit low-income people entitled to reimbursements for certain of their health care payments. He stole from a program for people in need and gave the money to his friends and himself. Today, what Murray has earned is a felony conviction and the prospect of serious prison time.”

According to the allegations in the Information, a previously filed Complaint, other documents filed in Manhattan federal court, and statements made at today’s guilty plea:

Medicaid is a federally funded program designed to provide low-income families with affordable health care. The HRA oversees the program and processes applications from New York City residents. Under Medicaid, individuals who successfully apply for Medicaid coverage can be reimbursed for eligible expenses submitted in the approximate three-month period prior to the application (“Pre-Enrollment Services”). In order to be reimbursed for Pre-Enrollment Services, the successful Medicaid applicant requesting reimbursement must provide proof that he or she made eligible health care payments out of pocket before applying for Medicaid. City employees known as Eligibility Specialists, working for HRA’s Medicaid Reimbursement Unit, receive and process requests for reimbursement using a computer system, and make recommendations for HRA supervisors as to whether a request should be approved.

From at least July 2009 until September 2010, MURRAY, an HRA Eligibility Specialist, exploited loopholes in HRA’s systems to both recommend and then separately approve the issuance of Medicaid reimbursement checks without meaningful oversight. MURRAY used the personal identifying information of his co-conspirators to create and unilaterally approve requests for reimbursement checks in their names. When the checks were sent to his friends and other associates, MURRAY demanded that they cash the checks and give him a substantial portion of the proceeds, often between 50 and 70 percent. MURRAY approved over $1.3 million in illicit Medicaid reimbursement requests during the course of the fraud.

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MURRAY, 52, of New York, New York, pled guilty to one count of conspiracy to commit health care fraud, which carries a maximum sentence of 10 years. Sentencing is scheduled for December 17, 2014, before Judge Berman.

The maximum potential sentence in this case is prescribed by Congress and is provided here for informational purposes only, as any sentencing of the defendant will be determined by the judge.

Mr. Bharara praised the investigative work of the FBI’s Health Care Fraud Task Force and the DOI for their assistance in this investigation, which he noted remains ongoing. The New York FBI Health Care Fraud Task Force was formed in 2007 in an effort to combat health care fraud in the greater New York City area. The task force comprises agents, officers, and investigators from the FBI, NYPD, the New York State Insurance Fraud Bureau, U.S. Department of Labor, U.S. Office of Personnel Management Inspector General, U.S. Food and Drug Administration, New York State Attorney General’s Office, New York State Office of Medicaid Inspector General, New York State Health and Hospitals Inspector General, and the National Insurance Crime Bureau.

This case is being handled by the Office’s Public Corruption Unit. Assistant United States Attorney Martin S. Bell is in charge of the prosecution.

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