Pilgrim Psychiatric official charged with insurance fraud

The affiliate director of operations at Pilgrim Psychiatric Middle submitted almost 450 false medical claims underneath his spouse’s title for companies by no means supplied, bilking taxpayers out of greater than $130,000, Suffolk County prosecutors stated Thursday.

Joseph Gottesman, 43, of Dix Hills, a licensed psychologist at Pilgrim, was arraigned Wednesday in Suffolk County First District Courtroom and charged with second-degree grand larceny and second-degree insurance coverage fraud, each felonies, and launched on his personal recognizance.

If convicted of the highest depend, Gottesman faces a most sentence of 5 to 15 years in jail. He’s due again in courtroom Dec. 15.

“The brazenness and extent of this fraudulent scheme is stunning,” stated Suffolk District Legal professional Timothy Sini.

Alex Bateman, Gottesman’s Uniondale-based protection legal professional, stated his shopper is an “achieved and efficient psychological well being skilled and a caring and dedicated husband and father. He has all the time taken his tasks in his private {and professional} life critically and these expenses are not any totally different. We’ll handle the precise allegations in courtroom appropriately.”

An investigation by the New York State Inspector Basic’s Workplace discovered Gottesman submitted 448 claims between December 2016 and Could 2019 for his spouse by which he solid the names of docs at six out-of-network medical suppliers, acquiring $132,514 from the Empire Plan and UnitedHealthcare insurance coverage firm, prosecutors stated.

By submitting claims for nonparticipating suppliers, the reimbursement checks had been despatched on to Gottesman, prosecutors stated.

The Empire Plan is the first well being advantages plan for the New York State Well being Insurance coverage Program, which covers lively and retired state staff, together with taking part native authorities and faculty district staff.

“This particular persons obvious greed led him to falsify paperwork and bilk taxpayers for greater than $132,000,” stated State Inspector Basic Letizia Tagliafierro. “Happily, impacted medical suppliers, the Empire Plan and UnitedHealthcares Particular Investigations Unit, had been suspicious of the variety of claims submitted and forwarded the matter to my workplace, the place we had been in a position to shortly uncover the scope of his fraud.”

The IG’s investigation discovered a number of events when Gottesmans spouse was not in state on dates claims had been submitted. For instance, he submitted three claims for companies in January 2019 when his spouse was in Florida and one other declare in February 2019 when she was on trip in Aruba, prosecutors stated,

The majority of the funds had been deposited into the Gottesmans joint checking account, with the defendant typically forging his spouses title to endorse most of the checks, prosecutors stated.

Gottesman is on administrative depart from Pilgrim Psychiatric Middle.

“When [State Office of Mental Health] was notified of the allegations in opposition to Mr. Gottesman, which weren’t associated to his state employment, we instantly positioned him on administrative depart whereas the NYS Inspector Basic and Suffolk County District Legal professional performed a full investigation,” stated company spokesman James Plastiras. “OMH assisted the IG and DA of their investigation and, upon his arrest, suspended Mr. Gottesman with out pay and is within the means of terminating him. An inner investigation by OMH discovered no theft of taxpayer-funded state assets.”

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