Married Couple Admits To Record $3.4M NY Medicaid Fraud Case: DA, NYS Comptroller

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

NYS Comptroller Thomas P. DiNapoli and Orange County District Attorney David M. Hoovler announced that 45-year-old Rohail Raja and 45-year-old Sharma Alam, both of New Windsor, pleaded guilty on Thursday to felony fourth-degree conspiracy.

The pleas are in connection with a scheme in which two Medicaid transportation companies, Unique Class Limo, Inc. and SNR Limo, Inc., which are owned by Raja and Alam respectively, stole from the NYS Department of Health by fraudulently billing for Medicaid transports that either did not take place, or did not occur in the manner that demands for payment indicated.

Raja and Alam each admitted that $3,434,730 was stolen from NYS's Medicaid program during the fraudulent billing scheme.

As part of the plea agreements, both Raja and Alam will be ordered to pay restitution in the amount of $3,434,730. If Raja and Alam pay $1,000,000 toward that restitution before being sentenced, the DA's Office will recommend that Raja be sentenced to 4-12 years in state prison.

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

"This is the largest Medicaid fraud scheme ever prosecuted by the Orange County District Attorney’s Office," DA 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 forensic 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 Crimes Taskforce for their dedication to investigate complex financial crimes."

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.

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, between April 15, 2020 and September 30, 2024, the couple stole over $3,434,730 from the NYS Medicaid Program.

At the time that Raja and Alam pleaded guilty, Unique Class Limo, Inc., appeared through an attorney and pleaded guilty to first-degree grand larceny. Unique Class Limo, Inc., through its attorney, admitted that it had stolen $2,666,634.00 through false Medicaid billings at the direction of Raja, as owner of that company. SNR Limo, Inc., pleaded guilty to second-degree grand larceny, and through its attorney, admitted that it had stolen $768,096.00 through false Medicaid billings occurring under the direction of Raja, as a high managerial agent of that company.

Both companies will be ordered to pay restitution in the amounts that they admitted having stolen and will be fined. Raja and Alam will be ordered to pay the combined sums of the larcenies committed under the auspices of each of the companies for a total of $3,434,730.00.

Alam, who admitted agreeing to the scheme, also who admitted filing a false attestation to further the conspiracy to steal the money, will be sentenced to a combination of jail time and probation, provided that $1,000,000 is paid toward the restitution prior to the couple being sentenced. If $1,000,000 toward restitution is not paid prior to sentencing, Raja faces up to 8 1/3 – 25 years in prison, and Alam faces (1 1/3 – 4 years in state prison.

"Raja Rohail and Shama Alam conspired to scam the Medicaid Program out of nearly $3 million," NYS Comptroller DiNapoli said. "They have now been held accountable for their crimes, are convicted felons, and will pay full restitution of the money they stole. My office will continue to work with law enforcement partners throughout the state and protect New York's vital Medicaid program from fraud. I thank District Attorney Hoovler for his continued partnership in fighting public fraud."

The couple is next scheduled to appear in Orange County Court on September 9.

"As Sheriff, my responsibility is to protect both the people of Orange County and the public dollars they rely on," Sheriff Arteta said. "Stealing from Medicaid is stealing from our most vulnerable residents, and this scheme undermined trust in a program meant to help those who truly need it. Our investigators, working alongside our partners in the District Attorney’s Office and the Comptroller’s Office, methodically exposed the truth and ensured those responsible were held to account. We will continue to defend the integrity of our community’s resources and make sure taxpayer money goes where it is intended."

The case is being prosecuted by Chief Assistant DA Christopher P. Borek.

New Yorkers can report allegations of fraud involving taxpayer money by calling the toll-free Fraud Hotline at 1-888-672-4555, by sending a complaint to this email address, or by mailing a complaint to: Office of the State Comptroller, Division of Investigations, 8th Floor, 110 State St., Albany, NY 12236.