Press Release  Springfield Man Indicted for Insurance Fraud Scheme

Springfield — A Springfield man has been indicted in connection with an alleged scheme to defraud an insurance company, Attorney General Maura Healey announced today.

Jose Rivera, age 36, of Springfield, was indicted this week by a Hampden County Grand Jury on Filing a False Health Care Claim (1 count) and Larceny over $1,200 (1 count). Rivera will be arraigned in Hampden County Superior Court on October 9.

The AG’s Office alleges that from June 2014 through October 2015, Rivera submitted more than 50 fraudulent electronic claims of reimbursement to Optum, a United HealthCare Inc. (UHC) subsidiary that processed his claims for mental health treatment for an out-of-network therapist. Rivera received health insurance with UHC through his place of work in Holyoke.

Rivera allegedly sought reimbursement for 322 separate days of psychotherapy and/or psychological diagnostic testing. UHC honored most of those claims and deposited more than $66,000 into Rivera’s bank account to reimburse him for the treatment that he had allegedly received from the therapist.

The AG’s office alleges that these claims contained incorrect contact and licensure information for the therapist. The AG’s office further alleges that the therapist Rivera claimed to see has never met nor provided any mental health services to him.

These charges are allegations and the defendant is presumed innocent until proven guilty.

This case is being prosecuted by Assistant Attorney General Gabriel Thornton with assistance from Philip Mantyla of AG Healey’s Insurance and Unemployment Fraud Unit, Victim Witness Advocate Amber Anderson, and from investigators at the Insurance Fraud Bureau. Optum provided critical assistance in investigating this case.

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