March 20, 2018

NH AG Announces Guilty Plea in Workers’ Compensation Fraud Case

Concord, NH – Attorney General Michael A. Delaney and NH Insurance Commissioner Roger A. Sevigny recently announced that on September 24, 2012, Phyllis J. Graham of Manchester, NH pleaded guilty in Hillsborough County Superior Court, North to Class A felony charges of theft by deception and attempted theft by deception. As part of the negotiated plea, Ms. Graham will serve twelve months at the House of Corrections, and repay $30,051 in restitution to Sedgwick Claims Management Services, the third party administrator for United Health Group of Hooksett, NH. Ms. Graham also pleaded guilty to unrelated felony charges of forgery and identity theft investigated by the Manchester Police Department prosecuted by the Hillsborough County Attorney’s Office. Ms. Graham’s jail time on the theft by deception scheme, will run consecutively to a jail sentence imposed on the identify theft and forgery charges.

Ms. Graham’s case was referred to the NH Insurance Department by the Manchester Police Department and Sedgwick Claims Management Services. In 2009 and 2010, Ms. Graham created fictitious bills and sought reimbursement for bills she said she had paid from Sedgwick, the administrator for her 2007 worker’s compensation settlement. Investigators discovered that Ms. Graham never received the services claimed, and that the bills submitted and the information on them were fraudulent.

Ms. Graham pleaded guilty to deceiving Sedgwick into paying her $20,500 for fabricated bills purporting to be from Dartmouth Hitchcock Medical Center in Bedford, NH. Ms. Graham admitted to creating a fictitious massage therapist who she claimed provided over $4,000 in massage therapy to treat her worker’s compensation claim related sciatica. Ms. Graham also pleaded guilty for deceiving Sedgwick into paying her $5,551.00 for emergent care she claimed to have received at St. Anne’s Hospital, in Fall River, MA.

In September of 2010, she submitted a fraudulent bill to Sedgwick and called the office demanding immediate reimbursement of $5,920 for treatment at St. Anne’s, her account was audited and the fraud scheme was discovered.

This prosecution was collaboration between the NH Attorney General’s Office and the NH Insurance Department Fraud Unit. Additional assistance was provided by detectives of the Manchester Police Department. The Attorney General and the Insurance Commissioner remind consumers that worker’s compensation provides an important safety net for workers, but that deceptions, like those perpetrated by Ms. Graham, are serious crimes that undermine the integrity of the worker’s compensation program and that, ultimately, we all pay for these crimes through increased costs.

Source: NH AG’s Office

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