SPRINGFIELD, Mass., Dec. 16 2004 – LAWFUEL – First with law news – A Williamstown man was convicted late yesterday in federal court of mail fraud, making false
statements in relation to health care benefits, and obstruction of justice.
United States Attorney Michael J. Sullivan; Kenneth W. Kaiser, Special
Agent in Charge of the Federal Bureau of Investigation in New England; and
James M. Benages, Regional Director of the U.S. Department of Labor’s Employee
Benefits Security Administration in Boston, announced that DAVID MICHAEL LEJA,
age 50, of 141 Luce Road in Williamstown, was convicted following a bench
trial by U.S. District Judge Michael A. Ponsor of 42 counts of mail fraud,
seven counts of false statements in relation to a health care benefits, and
one count of obstruction of justice. He was acquitted of one count of witness
tampering.
Evidence presented during the thirteen-day trial proved that LEJA, a
licensed insurance broker, who owns Berkshire Group Health Services at 85 Main
Street in North Adams, Massachusetts, falsified claims information for seven
self-funded group health insurance plans in an effort to obtain artificially
low stop loss insurance quotes for his clients. Stop-loss insurance protects
self-funded health plans from catastrophic losses by paying claims that exceed
a certain threshold. The insurance carrier relies on a group plan’s past
claims history in setting the payment threshold. The Court also found that
LEJA illegally used the mails in furtherance of his fraudulent scheme.
In addition to the mail fraud and false statement convictions, the Court
found that LEJA obstructed justice by fabricating additional bogus documents,
including an email that he sent to himself after surreptitiously accessing a
key government witness’s email account, that he planned to use at trial to
impeach the witness and undermine the government’s case against him. LEJA was
acquitted of a related witness tampering charge.
Judge Ponsor scheduled sentencing for March 16, 2005. LEJA faces up to 5
years in prison and a $250,000 fine on each of the mail fraud and false
statement counts and up to 10 years in prison and a $250,000 on the
obstruction of justice count.
The case was investigated by the U.S. Department of Labor’s Employee
Benefits Security Administration and the Federal Bureau of Investigation. It
is being prosecuted by Assistant U.S. Attorneys Karen L. Goodwin and Thomas J.
O’Connor, Jr., in Sullivan’s Springfield Office.
