Two women have been arrested in New York after prosecutors accused them of running a more than three-year-long scheme in which an unlicensed doctor allegedly treated patients while using a licensed nurse practitioner’s credentials to bill Medicaid for more than $105,000.
New York Attorney General Letitia James announced the arrests on Thursday, July 2, saying the alleged operation put patients at risk and undermined confidence in the state’s health care system.
Fake Doctor Accused of Treating Patients Without a License
“I’m announcing the arrest of two individuals for their roles in a scam at a Queens medical clinic where they provided medical treatment without a license and defrauded Medicaid,” James wrote on social media.
“This scheme put New Yorkers at risk and undermined the integrity of our health care system.”
According to the attorney general’s office, Francia Aguila, 53, of Farmington, and Gifty Appiah, 59, of Staten Island, were charged in connection with an alleged Medicaid fraud scheme centered at Steinway Hope Medical, a clinic in Astoria, Queens.
Prosecutors allege that Aguila practiced medicine without a medical license, while Appiah, a licensed nurse practitioner, allowed her professional credentials to be used to support fraudulent Medicaid billing.
How Prosecutors Say the Medicaid Fraud Scheme Worked
James said the alleged scheme operated from March 2021 through November 2024.
Investigators claim false Medicaid claims totaling $105,018 were submitted during that period to Medicaid-funded managed care organizations.
According to prosecutors, those claims falsely represented that Appiah had examined and treated patients.
Also Read: Nurse Practitioner Sentenced to Nearly 8 Years Over $12 Million Medicare Fraud Scheme
Court documents allege Aguila regularly saw patients at the clinic despite lacking authorization to practice medicine in New York.
Investigators say she introduced herself to patients as “Doctor Fran” and wore a white lab coat while providing medical care.
The attorney general’s office alleges Aguila examined patients, performed routine physical assessments, and issued prescription medications using Appiah’s identity and medical credentials.
Role of the Licensed Nurse Practitioner
Prosecutors also allege Appiah rarely appeared at the clinic but received approximately $10,000 each month while Aguila continued treating patients.
Attorney General James said the case highlights the dangers of allowing unlicensed individuals to provide medical care.
“New Yorkers in need of medical care sought treatment at Steinway Hope Medical, where they were taken advantage of by a fake doctor as part of an elaborate Medicaid fraud scheme,” James said in a statement as quoted by the New York Post.
She added that practicing medicine without a license places patients at risk while weakening public trust in the health care system.
“Practicing medicine without a license risks the lives of New Yorkers and undermines the integrity of our health care system,” James said.
Also Read: Nurse Practitioner Sentenced to Nearly 8 Years Over $12 Million Medicare Fraud Scheme
The attorney general said her office will continue investigating fraud involving Medicaid and unauthorized medical practice.
“My office will continue to root out fraud in our state’s Medicaid program and protect New Yorkers by bringing unlicensed practitioners to justice,” James said.
Charges and Potential Prison Sentences Explained
Authorities charged Aguila and Steinway Hope Medical with the unauthorized practice of a profession, first-degree falsification of business records, and unauthorized use of a professional title.
Appiah faces two counts of offering a false instrument for filing in the first degree.
Officials said the most serious charges carry a maximum prison sentence of four years if the defendants are convicted.
The investigation found that Medicaid reimbursement requests submitted during the alleged scheme identified Appiah as the medical provider even though prosecutors say Aguila was the person who actually treated patients.
The attorney general’s office alleges the arrangement allowed the clinic to continue receiving Medicaid payments while concealing Aguila’s lack of medical credentials.
Why the Case Raises Concerns About Medicaid Oversight
The case has renewed concerns about oversight of Medicaid-funded providers and the safeguards intended to prevent fraudulent billing.
James’ office did not indicate how many patients were seen during the alleged scheme or whether any suffered physical harm.
The investigation was conducted by the Medicaid Fraud Control Unit within the New York Attorney General’s Office.
The unit is responsible for investigating Medicaid provider fraud as well as abuse and neglect involving patients in medical facilities funded through Medicaid.
