New York Superintendent Gregory Serio, along with Albany District Attorney Paul Clyne, announced that Dierdre Wolberg, co-owner of State Opticians has been sentenced to six months house arrest and five years felony probation for reportedly defrauding the Capital District Physicians’ Health Plan, Inc. (CDPHP) of Albany by submitting bogus claims. Prior to sentencing, Wolberg reimbursed CDPHP $37,000 for State Opticians’ bogus claims submissions.
The investigation revealed that State Opticians reportedly sent claim forms to CDPHP with doctor’s signatures after the doctor had passed away. State Opticians backdated forms to coincide with the time when the doctor worked for State Opticians and had a contract with CDPHP, prior to his death. In addition, State Optician’s reportedly inflated some of their claims and submitted payment requests for services never performed.
“I am pleased that the Department’s vigorous investigation with the Albany County District Attorney’s office into the improprieties of State Opticians has resulted in due justice for CDPHP and their policyholders,” said Serio. “Having insurance fraudsters make restitution for money thieved from the insurance system is a critical component to fighting insurance fraud and I applaud the District Attorney’s office for demanding such action and for their aggressive stance on fighting insurance fraud.”
“Since September of last year, as a result of member complaints, CDPHP’s Special Investigations Unit (SIU) has been reviewing claims submitted by State Opticians. The results of our investigation were promptly reported to the Fraud Bureau of the Department of Insurance,” said Karen Carpenter-Palumbo, senior vice president, government programs, CDPHP. “We are pleased that this investigation has been resolved and CDPHP will continue to be vigilant against health care system fraud.”
Wolberg was sentenced and admitted to grand larceny and insurance fraud, both Class D felonies and pled with the risk of state prison. Because the fraudulent claims were health insurance claims, Wolberg risks review and possible loss of her Optician’s license.
Wolberg was arrested on March 4 for reportedly attempting to obtain over $50,000 in fraudulent payments from CDPHP while actually securing $37,000. The investigation also lead to arrest of Caroline Burr-McCann, 35, a former billing clerk for State Opticians who was charged with insurance fraud on April 8. Burr-McCann’s case is pending.