The U.S. Attorney’s Office in Springfield Mass. announced the indictment of David Michael Leja, an insurance broker from Williamstown Mass, on fraud charges relating to “stop-loss” coverage he brokered for seven group health insurance plans in Western Mass.
Leja owns Berkshire Group Health Services at 85 Main Street, North Adams, Massachusetts. He was charged with falsifying documents for the health insurance plans while working at Kimbell Financial, Inc. A statement by the U.S. Attorney’s Office indicated that “The fifty-five count indictment alleges that between 1997 and 1998, LEJA falsified the claims history for the health insurance plans in order to obtain more favorable “stop-loss” insurance.”
The announcement pointed out that an “insurance carrier relies on a group plan’s past claims history in setting the payment threshold.” Leja is charged with mail fraud and making false statements in connection with the health care plans by submitting the incorrect information.
If convicted, Leja faces a maximum penalty of five years in prison and a $250,000 fine on each of the fifty-five counts.