Attorney General Letitia James today announced charges against Leslie Montgomery, 49, of the Bronx and her healthcare clinic, Healthy Living Community Center (Healthy Living), for defrauding the New York State Medicaid program by submitting false claims to Medicaid and to MetroPlus, a Medicaid-funded managed care organization (MCO), for customized back braces. Montgomery and Healthy Living allegedly pocketed more than $4 million from the illegal scheme that involved tricking New Yorkers into divulging personal information under the false pretense of applying for affordable housing. Montgomery is charged in the New York City Criminal Court, Bronx County, with Grand Larceny in the First Degree and Identity Theft in the First Degree.
“Using affordable housing as a pretense for Medicaid theft is reprehensible,” said Attorney General James. “My office will do everything in our power to stop New Yorkers in need of housing assistance from being left in the lurch and having their information be unwittingly used for theft from New York taxpayers.”
The Attorney General’s Medicaid Fraud Control Unit (“MFCU”) alleges that Montgomery regularly advertised online a housing assistance program as a ruse to lure Medicaid recipients to Healthy Living, where they had to divulge their personal Medicaid information in order to “qualify for the program.” There was no legitimate housing assistance program, prosecutors contend, and there was no housing provided to those individuals who responded to the advertisements.
Instead, Montgomery allegedly stole their personal information to submit false claims to Medicaid for highly specialized, custom-molded back braces. Almost every single Healthy Living recipient had back braces billed in their name. None, allegedly, received custom-molded back braces. In some instances, Montgomery provided a $20 “off-the-shelf” back brace mailed directly from Amazon to the recipient. Other times, she provided nothing at all, yet she billed Medicaid between $750 and $1,550 per back brace.
Relying on the accuracy of claims submitted by Montgomery and Healthy Living, the Office of Attorney General (OAG) alleges that Medicaid-funded MCOs, such as MetroPlus, paid more than $4 million to Montgomery, directly and through Health Living.
In papers filed today, Montgomery was charged with Grand Larceny in the First Degree, a Class B felony, and Identity Theft in the First Degree, a Class D felony. Grand Larceny in the First Degree carries a maximum sentence of incarceration of twenty-five years.
Montgomery was arraigned earlier today in New York City Criminal Court, Bronx County before the Honorable Jeffrey Zimmerman where she was released under the conditions that she surrenders her passport, waives extradition, and restricts travel to within New York state.
The charges against the defendant are accusations, and the defendants are presumed innocent unless, and until, proven guilty in a court of law. The Attorney General would like to thank the New York State Department of Health, Office of the Medicaid Inspector General, and the MCO MetroPlus for their assistance and cooperation in this investigation.
MFCU’s investigation was led by Investigator Shavaun Clawson with the assistance of Supervising Investigator James Briscoe, under the supervision of Deputy Chief Investigator Kenneth Morgan. The underlying financial audit was completed by Senior Auditor Investigator Ying Tuo with the assistance of NYC Regional Deputy Chief Auditor Jonathan Romano and NYC Regional Chief Auditor Thomasina Smith. Also assisting in the investigation were Legal Assistants Nicholas Matthews and Victoria Sepe and Data Scientist Si Lok Chao.
The criminal case is being prosecuted by Special Assistant Attorneys General Hayley Campbell and Anjna Kapoor, along with Senior Counsel David Arias with assistance from NYC Regional Director Christopher M. Shaw. Thomas O’Hanlon is MFCU’s Chief of Criminal Investigations-Downstate. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division of Criminal Justice is led by Chief Deputy Attorney General for Criminal Justice José Maldonado, and is overseen by First Deputy Attorney General Jennifer Levy.
Reporting Medicaid Provider Fraud
The Medicaid Fraud Control Unit of the Office of the New York State Attorney General enforces laws that protect the public fisc by addressing Medicaid provider fraud and that protect nursing home residents from abuse and neglect. If an individual believes they have information about Medicaid provider fraud or about an incident of abuse or neglect of a nursing home resident, they can file a confidential complaint online on the OAG website at ag.ny.gov/nursinghomes, or by calling the MFCU hotline at 212-417-5397. If the situation is an emergency, please call 911.
MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $60,071,905 for Federal fiscal year (FY) 2019-20, of which $45,053,932 is federally funded. The remaining 25 percent of the approved grant, totaling $15,017,973 for FY 2019-20, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, MFCU regularly returns more to the state than it receives in state funding.