Melissa Panayiota Kanes, New York, NY was charged with healthcare fraud, money laundering, and aggravated identity theft in connection with a scheme to submit more than $800,000 in fraudulent healthcare claims, including by using, over the course of multiple years, the identities of three per diem chiropractors when submitting claims in an effort to hide the defendant’s association with the claims.
Between 2014 and 2016, Kanes submitted a high volume of insurance claims to one of the largest private health insurance companies in the country (“Insurer-1”). Insurer-1 served as the third-party claims administrator for various health plans, including a health plan covering the employees of a large consulting firm (“Victim Employer-1”). At the outset, Kanes submitted the bills using companies publicly associated with her and her own identification number. But in 2016, Insurer-1 flagged Kanes for improper billing and slowed or ceased payments to Kanes. Thereafter, Kanes continued to submit claims to Insurer-1, but took steps to hide Kanes’s association with the bills.
In particular, Kanes submitted bills under the names and identification numbers of two newly incorporated companies (“New Company-1” and “New Company-2”), and three newly recruited per diem chiropractors (“Victim Chiropractor-1,” “Victim Chiropractor-2,” and “Victim Chiropractor-3”; together, the “Victim Chiropractors”), without the Victim Chiropractors’ knowledge or consent.
