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Justice News

Department of Justice
U.S. Attorney’s Office
Western District of New York

Monday, September 29, 2014

Social Worker Found Guilty by a Federal Jury of Defrauding Blue Cross Blue Shield


BUFFALO, N.Y.--U.S. Attorney William J. Hochul, Jr. announced today that a federal jury in Buffalo has convicted Nina Jafari, a licensed clinical social worker, 63, of Amherst, N.Y., of four counts of health care fraud. The defendant faces a maximum penalty of 10 years in prison, a fine of $250,000 or both when sentenced.

“One of the reasons for the high cost of health care in this country is fraud,” said U.S. Attorney Hochul. “Thanks to today’s convictions, a woman who abused her position as a health care provider to illegally enrich herself will no longer be able to run up costs for the rest of the public.”

Assistant U.S. Attorneys Michael DiGiacomo and Aaron J. Mango, who handled the prosecution of the case, stated that the defendant defrauded Blue Cross Blue Shield of Western New York. Jafari submitted reimbursement claim forms to the insurance provider for services that were not rendered. For example, a witness for the Government testified that the defendant submitted claim forms for both he and his wife who were not even patients of Jafarai. The defendant received payment for 80 minute sessions for both the husband and wife.  

The Government’s evidence also included tape recorded conversations between the defendant and a patient. In those conversations, Jafari instructed the patient not to share any information with Blue Cross Blue Shield regarding dates of service.

The amount that the defendant defrauded the insurance carrier totaled approximately $125,000.

The verdict is the culmination of an investigation on the part of Special Agents of the Federal Bureau of Investigation Health Care Fraud Task Force.

Sentencing is scheduled for December 5, 2014 at 2:00 p.m. in Buffalo before Judge Elizabeth A. Wolford who presided over the trial of the case.
Updated November 19, 2014