July 19, 2021
|
Albany, NY

Pilgrim Psych Center's Former Associate Director Of Operations Pleads Guilty To Stealing $132k From Empire Plan By Submitting False Claims Under Wife's Name

Pilgrim Psych Center's Former Associate Director Of Operations Pleads Guilty To Stealing $132k From Empire Plan By Submitting False Claims Under Wife's Name
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New York State Inspector General Letizia Tagliafierro today announced the guilty plea of the former associate director of operations at West Brentwood’s Pilgrim Psychiatric Center who obtained more than $132,000 from the Empire Plan/UnitedHealthcare insurance company by submitting hundreds of false claims under his wife’s name for services that were never provided.

Joseph Gottesman, 43, of Dix Hills, a licensed psychologist, pleaded guilty today before Justice John Collins in Riverhead Supreme Court to Grand Larceny in the Second Degree (C Felony). Pursuant to a plea agreement, Gottesman paid $132,514 in restitution to UnitedHealthcare and must complete 420 hours of community service. Additionally, will be on probation for one year and he is resigning from the New York State Office of Mental Health (Gottesman had been suspended without pay since November 2020).

“This individual’s scheme to steal from taxpayers has finally caught up with him and he will no longer be employed by New York State,” said Inspector General Letizia Tagliafierro. “The suspicious number of claims submitted were flagged through the vigilance of the insurer and medical providers and then provided to my office. Through our ongoing partnership with District Attorney Timothy Sini’s Office, we were able to uncover the full scope of the fraud and hold him accountable for his actions.”

“This is a great result for taxpayers that guarantees full reimbursement of these stolen public funds,” Suffolk County District Attorney Timothy D. Sini said. “I thank the prosecutors and investigators who uncovered this scheme, and thank Inspector General Tagliafierro for her continued partnership with my Office in holding public employees accountable.”

The NYS Health Insurance Program (NYSHIP) is administered by the NYS Department of Civil Service and covers active and retired State employees, as well as participating local government and school district employees. The Empire Plan is the primary health benefits plan for NYSHIP.

The Inspector General’s investigation determined Gottesman fabricated 448 claims by stealing the identity of at least six different out-of-network (non-participating) medical providers. By submitting claims for non-participating providers, the reimbursement checks were sent directly to Gottesman.

Specifically, the Inspector General’s investigation found that Gottesman filed the false claims between December 2016 and May 2019 for his wife, resulting in $132,514 being paid to the couple for services never delivered. Most of the funds were deposited into the Gottesmans’ joint checking account, with Gottesman forging his wife’s name to endorse many of the checks.

The investigation determined that there were several occasions when Gottesman’s wife was not even in New York State on dates for which claims were submitted. For example:

  • Gottesman submitted three false claims for his wife for services from three different providers in January 2019. However, credit card purchases and social media postings proved that she was in Florida at the time.
  • Gottesman submitted a false claim for his wife for services on February 16, 2019. However, a review of his wife’s Facebook postings show she was on vacation in Aruba from February 14-17.

Inspector General Tagliafierro thanked Suffolk County District Attorney Sini and his office for their assistance with the investigation and for prosecuting this matter. She also thanked the Empire Plan, UnitedHealthcare’s Special Investigations Unit and the NYS Office of Mental Health for their assistance with the investigation.

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