Five Mass. residents charged in $1 million health care fraud scheme

Five Massachusetts residents and one New York woman have been accused of carrying out a health care fraud scheme in which they billed health insurance companies for over $1 million in fake medical costs for treatment they supposedly received while overseas.

Dorchester resident Brendon Ashe, 40, 36-year-old Roxbury resident Aqiyla Atherton, 40-year-old Randolph resident Darline Cobbler, 36-year-old Brockton resident Henry Ezeonyido, 36-year-old Brockton resident Chinenye Nwodim and 34-year-old Brooklyn resident Ariel Lambert are all facing one count of health care fraud, the Massachusetts U.S. Attorney’s Office said in a press release.

The six defendants are alleged to have submitted fraudulent health insurance claims for expensive medical treatments they purportedly paid for out-of-pocket while traveling outside the U.S., the U.S. Attorney’s office said. The claims — which were billed to four health insurance companies — said that the defendants had been hospitalized after being injured in stabbings, hit-and-run car crashes and shootings.

The defendants are also accused of providing fake records to support their claims, including bank documents purportedly showing hospital payments, medical records purportedly showing the treatments they received and police reports describing the incidents in which they were injured, the U.S. Attorney’s office said. Some of the fake supporting documents were “nearly identical” to one another, down to the date of the incident, the location at which it happened and the nature of the incident.

Prosecutors allege that the defendants were in the U.S. at the times they claimed to have been hospitalized overseas, the U.S. Attorney’s office said. Additionally, some of the defendants are alleged to have undergone unrelated medical treatments in the U.S. at the times they reported as having received care outside the U.S.

“These defendants allegedly fabricated over $1 million in insurance claims for injuries that never happened in a brazen abuse of our healthcare system,” Acting U.S. Attorney Joshua Levy said in the release. “This kind of deceit is not only illegal, it victimizes every law-abiding person by diverting resources from those truly in need and driving up costs for everyone.”

All six defendants appeared for their arraignments in federal court in Boston and were released on their own person recognizance, the U.S. Attorney’s office said. The charge of health care fraud carries a sentence of up to 10 years in prison, up to three years of supervised release and a fine of up to $250,000 or twice the gross gain or loss from the offense.

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