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Ex-Cedars worker gets 4 years in fraud case

A former Cedars-Sinai Medical Center employee was sentenced to four years and eight months in prison after pleading guilty Monday to stealing patient information to defraud insurance firms of $354,000.

The hospital had sent letters in December to more than 1,000 patients, warning them that their information had been found during a search of the home of James Allen Wilson, who worked in the billing department from 2003 to 2007.

Wilson was charged with using the information of 12 of the patients, all of them L.A. Unified School District employees who had filed workers’ compensation claims, to bill insurance firms more than $1.3 million for treatment that was never provided. The scam netted him $354,000, said Deputy Dist. Atty. Wendy Derzaph of the Healthcare Fraud Division.

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The affected companies include: Sedgwick CMS, Specialty Risk Services, Continental Casualty Co., Liberty Mutual, Southern California Regional Management, Travelers and Zurich Insurance, said Jane Robison, a spokeswoman for the L.A. County district attorney’s office.

Wilson, 45, of Los Angeles, pleaded guilty to one count each of identity theft, insurance fraud and grand theft, along with two counts of failure to file income tax returns in 2005 and 2007, Derzaph said in a statement.

In addition, Superior Court Judge Samuel Mayerson ordered Wilson to pay $354,000 in restitution to the school district, which paid for treatment employees never received, and $62,000 in back taxes and penalties to the state Franchise Tax Board, authorities said.

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alexandra.zavis@latimes.com


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