Couple Arrested In Record $2.9M NY Medicaid Fraud Case: DA, NYS Comptroller

NEW WINDSOR, NY — A married Orange County couple defrauded New York's Medicaid program to the tune of millions of dollars, according to officials.

New York State Comptroller Thomas P. DiNapoli and Orange County DA David M. Hoovler announced that 45-year-old Rohail Raja and 45-year-old Sharma Alam were arrested on Thursday, and charged with first-degree larceny related to a scheme to defraud the NYS Medicaid program of millions of dollars.

Raja and Alam were arraigned in the City of Newburgh Court on a felony complaint which alleges that between February 1, 2020 and August 30, 2024, the couple stole over $2.9 million in Medicaid funds from the NYS Department of Health. The thefts took place through fraudulent claims submitted by the couple's two Medicaid transportation companies, according to investigators.

"These defendants allegedly systematically schemed to steal nearly 3 million dollars in much needed funds for the health care of deserving New Yorkers," DiNapoli said. "Thanks to my partnership with District Attorney Hoovler they are now being held accountable. My office will continue to work with our law enforcement partners across the state to fight Medicaid fraud and abuse and protect our Medicaid system."

A joint investigation was conducted by the Orange County DA's Office, the Office of the NYS Comptroller, the Orange County Sheriff's Office, and the Orange County White Collar Crimes Taskforce. They were assisted by the NYS Office of the Medicaid Inspector General and the Hudson Valley Crime Analysis Center.

Based upon the investigation's findings, the DA's Office applied for a search warrant which was executed at the couple's Town of New Windsor home by investigators from the Orange County DA's Office, the Orange County Sheriff's Office, and the Office of the State Comptroller.

"This is the largest Medicaid fraud scheme ever prosecuted by the Orange County District Attorney's Office," Hoovler said. "I am grateful to Comptroller DiNapoli, and his staff, for partnering with the District Attorney's Office and the Orange County White-Collar Crimes Taskforce on this important investigation. The work of the investigators and auditors of the Office of State Comptroller was crucial to this investigation. I also thank Sheriff Arteta for continuing to partner with my office, and the other members of the White-Collar Taskforce, in investigating complex financial crimes."

The couple's two companies were paid by the NYS Department of Health to provide transportation to Medicaid recipients to travel to and from approved Medicaid medical service providers.

During the investigation, claims for payments submitted by the couple's companies were compared to records from the Medicaid medical service providers in the claims. An auditor from the Office of the NYS Comptroller found that the NYS Department of Health had paid the couple over $2 million for supposedly transporting Medicaid recipients to Medicaid health care providers on dates and time when the provider records show that no such visits took place.

In addition, a review of the claims submitted by the couple's companies during that same time period found that the companies had been fraudulently submitting claims to the NYS Department of Health which falsely claimed that the companies had transported Medicaid recipients separately to medical appointments. In reality, they had transported multiple Medicaid recipients in one trip. As a result of those false claims, the couple's companies received more than $895,000 than they were entitled to.

The investigation determined that through these two schemes, the couple stole over $2,900,000 from the NYS Medicaid Program. The investigation is ongoing and anyone with information is asked to contact the Orange County DA's Office.

Raja and Alam were remanded to the Orange County Jail in lieu of bail set at $1 million cash, or $5 million partially secured bond, or $10 million unsecured bond.

The couple is next scheduled to appear in the Town of New Windsor Justice Court on November 5.

"This case is a prime example of why the Orange County Sheriff’s Office and Orange County DA’s office created the White Collar Crime Task Force," Sheriff Arteta said. "These investigations ensure that we hold the people taking advantage of public funding accountable. The aftermath of these crimes impacts our community in many ways. We need to prevent fraudulent claims from causing a burden on our Medicaid system so that the funding is there for those who need it. A job well done by everyone involved."