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Pilgrim Psychiatric official charged with insurance fraud

An exterior view of Pilgrim Psychiatric Center facility

An exterior view of Pilgrim Psychiatric Center facility in Brentwood Sept. 26, 2019.  Credit: Newsday/J. Conrad Williams Jr.

The associate director of operations at Pilgrim Psychiatric Center submitted nearly 450 false medical claims under his wife's name for services never provided, bilking taxpayers out of more than $130,000, Suffolk County prosecutors said Thursday.

Joseph Gottesman, 43, of Dix Hills, a licensed psychologist at Pilgrim, was arraigned Wednesday in Suffolk County First District Court and charged with second-degree grand larceny and second-degree insurance fraud, both felonies, and released on his own recognizance.

If convicted of the top count, Gottesman faces a maximum sentence of five to 15 years in prison. He is due back in court Dec. 15.

"The brazenness and extent of this fraudulent scheme is shocking," said Suffolk District Attorney Timothy Sini.

Alex Bateman, Gottesman's Uniondale-based defense attorney, said his client is an "accomplished and effective mental health professional and a caring and committed husband and father. He has always taken his responsibilities in his personal and professional life seriously and these charges are no different. We will address the specific allegations in court appropriately."

An investigation by the New York State Inspector General's Office found Gottesman submitted 448 claims between December 2016 and May 2019 for his wife in which he forged the names of doctors at six out-of-network medical providers, obtaining $132,514 from the Empire Plan and UnitedHealthcare insurance company, prosecutors said.

By submitting claims for nonparticipating providers, the reimbursement checks were sent directly to Gottesman, prosecutors said.

The Empire Plan is the primary health benefits plan for the New York State Health Insurance Program, which covers active and retired state employees, along with participating local government and school district employees.

"This individual’s apparent greed led him to falsify documents and bilk taxpayers for more than $132,000," said State Inspector General Letizia Tagliafierro. "Fortunately, impacted medical providers, the Empire Plan and UnitedHealthcare’s Special Investigations Unit, were suspicious of the number of claims submitted and forwarded the matter to my office, where we were able to quickly uncover the scope of his fraud."

The IG's investigation found several occasions when Gottesman’s wife was not in state on dates claims were submitted. For example, he submitted three claims for services in January 2019 when his wife was in Florida and another claim in February 2019 when she was on vacation in Aruba, prosecutors said,

The bulk of the funds were deposited into the Gottesmans’ joint checking account, with the defendant often forging his wife’s name to endorse many of the checks, prosecutors said.

Gottesman is on administrative leave from Pilgrim Psychiatric Center.

"When [State Office of Mental Health] was notified of the allegations against Mr. Gottesman, which were not related to his state employment, we immediately placed him on administrative leave while the NYS Inspector General and Suffolk County District Attorney conducted a full investigation," said agency spokesman James Plastiras. "OMH assisted the IG and DA in their investigation and, upon his arrest, suspended Mr. Gottesman without pay and is in the process of terminating him. An internal investigation by OMH found no theft of taxpayer-funded state resources."

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