NEW YORK, United States — Two women have been arrested and charged in New York over an alleged Medicaid fraud scheme in which prosecutors say an unlicensed individual treated patients while using a licensed nurse practitioner’s credentials to bill the state healthcare programme more than $105,000.
New York Attorney General Letitia James announced the charges on Thursday, saying the alleged scheme endangered patients and undermined confidence in the integrity of the state’s healthcare system.
“I’m announcing the arrest of two individuals for their roles in a scam at a Queens medical clinic where they provided medical treatment without a license and defrauded Medicaid,” James said in a statement.
“This scheme put New Yorkers at risk and undermined the integrity of our health care system.”
According to prosecutors, Francia Aguila, 53, of Farmington, and Gifty Appiah, 59, of Staten Island, were charged following investigations into operations at Steinway Hope Medical, a clinic in Astoria, Queens.
Alleged three-year scheme
The Attorney General’s Office alleges the scheme operated between March 2021 and November 2024, during which fraudulent Medicaid claims totalling $105,018 were submitted to Medicaid-funded managed care organisations.
Investigators claim Aguila, who was not licensed to practise medicine in New York, routinely examined patients while presenting herself as “Doctor Fran.” She allegedly wore a white lab coat, conducted physical examinations and prescribed medication using Appiah’s professional credentials.
Court documents further allege that Appiah, a licensed nurse practitioner, rarely attended the clinic but allowed her credentials to be used to support Medicaid billing while receiving approximately $10,000 per month.
Prosecutors contend that reimbursement claims falsely identified Appiah as the treating medical provider even though Aguila allegedly delivered the medical services.
Charges filed
Aguila and Steinway Hope Medical have been charged with the unauthorised practice of a profession, first-degree falsification of business records and unauthorised use of a professional title.
Appiah faces two counts of offering a false instrument for filing in the first degree.
Authorities said the most serious offences carry a maximum prison sentence of four years if the accused are convicted.
Investigation continues
Attorney General James said the case highlights the dangers posed by unlicensed individuals providing healthcare services.
“New Yorkers in need of medical care sought treatment at Steinway Hope Medical, where they were taken advantage of by a fake doctor as part of an elaborate Medicaid fraud scheme,” she said.
“Practicing medicine without a license risks the lives of New Yorkers and undermines the integrity of our health care system.”
The investigation was conducted by the Medicaid Fraud Control Unit within the New York Attorney General’s Office, which investigates Medicaid provider fraud as well as abuse and neglect involving patients in Medicaid-funded healthcare facilities.
Prosecutors have not disclosed how many patients were treated during the alleged scheme or whether any suffered physical harm. The investigations remain ongoing, and the charges are allegations that have yet to be tested in court.