Medical Billing Company Owner Sentenced for Health Care Fraud

ALBANY, NEW YORK – Scott Newcombe, age 41, of Plattsburgh, New York, was sentenced today to 1 year of probation, and ordered to pay $34,583.21 in restitution, for health care fraud.

Acting United States Attorney Daniel Hanlon; Craig L. Tremaroli, Special Agent in Charge of the Albany Field Office of the Federal Bureau of Investigation (FBI); and Naomi Gruchacz, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), New York Regional Office, made the announcement.

As part of his guilty plea, Newcombe admitted that from approximately April 2020 through April 2023, he acted as the office manager and health care claims biller for two physicians’ practices in Plattsburgh through a company that he formed called SJ Healthcare Management Services, LLC (SJHMS).  SJHMS charged a fixed monthly fee under which Newcombe performed various management, administrative, and billing services for the practices.  He admitted that he submitted false and fraudulent claims to public and private insurers on behalf of those practices for services that, in some instances, were never provided and, in other instances, were provided at lower reimbursement rates than the amounts billed.  For example, Newcombe admitted that he submitted claims to insurers for medical procedures that were purportedly performed by a provider on him but which, in fact, never occurred.

The FBI and HHS-OIG investigated this case.  Assistant U.S. Attorneys Michael D. Gadarian and Adam J. Katz prosecuted the case.