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Cyrus R. Vance, Jr.

District Attorney, New York County

For Immediate Release
November 20, 2012

DA VANCE ANNOUNCES SENTENCING OF HERLINA LUIS TO 3-TO-6 YEARS IN PRISON FOR MENTAL HEALTH INSURANCE SCAM

Manhattan District Attorney Cyrus R. Vance, Jr., today announced the sentencing of HERLINA LUIS, 37, to 3-to-6 years in prison for defrauding her insurance carrier and submitting hundreds of false claims for mental health care treatments that never occurred. On November 7, 2012, LUIS pleaded guilty to the top charge of the indictment, Grand Larceny in the Second Degree.

 
“Health care scams harm honest policyholders by affecting insurance rates, which, for many New Yorkers, are already too high,” said District Attorney Vance. “My Office will continue to work with our partners at the New York State Department of Financial Services to root out insurance fraud.”
 
According to the defendant’s guilty plea and documents filed in court, LUIS submitted hundreds of false reimbursement claims for mental health services that were supposedly provided to the defendant and her family by a doctor in Brooklyn. In fact, both the services rendered and the doctor’s information were fabricated by the defendant in order to collect money from her mental health insurance carrier, OptumHealth Behavioral Solutions (“OHBS”), which requires policy holders who receive treatment from out-of-network providers to pay for treatment themselves and then submit claims to OHBS for reimbursement. Between July 2010 and November 2011, LUIS submitted more than 1,000 false reimbursement claims for approximately $257,000 worth of mental health services.
 
Assistant District Attorney Heather Manley handled the prosecution of this case under the supervision of Assistant District Attorney Thomas Wornom, Chief of the Special Prosecutions Bureau, and Assistant District Attorneys Archana Rao and Judy Salwen, Deputy Chiefs of the Special Prosecutions Bureau. District Attorney Vance also thanked Douglas Libertucci, Investigator with the NYS Department of Financial Services (DFS) Criminal Investigations Unit, who investigated the cases under the supervision of Frank Orlando, Director of Criminal Investigations for DFS and Joy Feigenbaum, Executive Deputy Superintendent of DFS, and OptumHealth Behavioral Solutions for their cooperation.
 
Defendant Information:
 
HERLINA LUIS, D.O.B. 1/19/1975
Brooklyn, NY
 
Convicted:
Grand Larceny in the Second Degree, a class C felony, 1 count
 
Sentenced:
3-to-6 years in prison
 
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