Springfield Man Indicted With Defrauding Health Insurance Co.

SPRINGFIELD, MA—A Springfield man has been indicted in connection with an alleged scheme to defraud an insurance company, Attorney General Maura Healey announced on Friday.

Jose Rivera, 36, Springfield, was indicted by a Hampden County Grand Jury on Filing a False Health Care Claim (1 count) and Larceny over $1,200 (1 count). Rivera will be arraigned in Hampden County Superior Court on Oct. 9.

According to the AG, Rivera submitted more than 50 fraudulent electronic claims of reimbursement to Optum from June, 2014, through October, 2015. Optum, a United HealthCare subsidiary processed his claims for mental health treatment for an out-of-network therapist. Rivera received health insurance with UHC through his place of work in Holyoke.

Rivera allegedly sought reimbursement for 322 separate days of psychotherapy and/or psychological diagnostic testing. UHC honored most of those claims and deposited more than $66,000 into Rivera’s bank account to reimburse him for the treatment that he had allegedly received from the therapist, said the announcement.

The AG’s office alleges that these claims contained incorrect contact and licensure information for the therapist. The AG’s office further alleges that the therapist Rivera claimed to see has never met nor provided any mental health services to him.

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