Mass. Man Convicted in Health Care Benefits Fraud

December 16, 2004

A Williamstown, Massachusetts man was convicted late Wednesday in federal court of mail fraud, making false statements in relation to health care benefits, and obstruction of justice.

United States Attorney Michael Sullivan; Kenneth Kaiser, Special Agent in Charge of the Federal Bureau of Investigation in New England; and James Benages, Regional Director of the U.S. Department of Labor’s Employee Benefits Security Administration in Boston, announced that David Michael Leja, 50, was convicted following a bench trial by U.S. District Judge Michael Ponsor of 42 counts of mail fraud, seven counts of false statements in relation to a health care benefits, and one count of obstruction of justice. He was acquitted of one count of witness tampering.

Evidence presented during the 13-day trial reportedly proved that Leja, a licensed insurance broker, who owns Berkshire Group Health Services at 85 Main Street in North Adams, Massachusetts, falsified claims information for seven self-funded group health insurance plans in an effort to obtain artificially low stop loss insurance quotes for his clients.

Stop-loss insurance protects self-funded health plans from catastrophic losses by paying claims that exceed a certain threshold. The insurance carrier relies on a group plan’s past claims history in setting the payment threshold. The Court also found that Leja illegally used the mails in furtherance of his fraudulent scheme.

In addition to the mail fraud and false statement convictions, the Court found that Leja obstructed justice by fabricating additional bogus documents, including an email that he sent to himself after surreptitiously accessing a key government witness’s email account, that he planned to use at trial to impeach the witness and undermine the government’s case against him. Leja was acquitted of a related witness tampering charge.

Judge Ponsor scheduled sentencing for March 16, 2005. Leja faces up to 5 years in prison and a $250,000 fine on each of the mail fraud and false statement counts and up to 10 years in prison and a $250,000 on the obstruction of justice count.

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