A former Amtrak employee has admitted his involvement in a massive health care fraud scheme that defrauded Amtrak’s health insurance plan of over $11 million. The scheme lasted for more than three years, from 2019 to 2022, and included a network of Amtrak workers and health care providers who illegally claimed reimbursement for services that were never provided.
A Serious Crime: What Happened?
Rodolfo Rivera, 41, of Clayton, Delaware, was the central figure in this scheme. Rivera, who worked for Amtrak, pleaded guilty to conspiring with others to commit health care fraud. He appeared before U.S. District Judge Madeline Cox Arleo in Newark federal court to admit his role. Along with Rivera, nine other people, all Amtrak employees, were charged with similar crimes.
According to the U.S. Attorney’s office, Rivera and his co-conspirators worked together to submit fraudulent claims for health care services that were neither necessary nor provided. They managed to get cash kickbacks from health care providers, like acupuncturists and podiatrists, who agreed to allow their services to be billed to Amtrak’s health insurance plan. The result? Amtrak’s health care plan ended up paying millions of dollars for services that never happened.
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The scam went on for years, from January 2019 through June 2022. During this period, Rivera and his co-conspirators got the Amtrak health care plan to pay out more than $2 million in fraudulent claims related to Rivera’s own medical needs, his dependents, and other employees he recruited into the scam. In total, the scheme led to more than $11 million being paid out for fraudulent claims.
Kickbacks and False Claims
One of the most troubling parts of this case is the way Rivera and his co-conspirators received money in return for their involvement. They were paid in cash kickbacks from health care providers who were part of the fraud. Rivera, for example, received thousands of dollars in kickbacks from two health care professionals: Punson Figueroa, an acupuncturist, and Michael DeNicola, a podiatrist.
Figueroa, who had been part of the scam, previously pleaded guilty to conspiracy to commit health care fraud. In September 2024, he was sentenced to 34 months in prison for his role in the scheme. DeNicola also pleaded guilty in 2022 to the same charge, along with other related offenses. His sentencing is still pending.
The actions of Rivera and his co-conspirators have caused significant harm. Not only did they steal millions of dollars from Amtrak’s health insurance plan, but they also put people’s health and trust in the system at risk. Amtrak employees who relied on their insurance benefits were affected by this fraud, which distorted the use of health resources.
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How the Authorities Got Involved
The investigation into the fraud was led by a team of special agents from various law enforcement agencies. Special agents from the Amtrak Office of Inspector General were among the main investigators, working under the direction of Special Agent in Charge Michael J. Waters. Other law enforcement agencies, including the Amtrak Police Department and the Drug Enforcement Administration (DEA), also helped with the investigation.
Their hard work eventually led to Rivera’s guilty plea, as well as charges against the other nine individuals involved. The case is being prosecuted by Assistant U.S. Attorneys Jessica R. Ecker and Katherine M. Romano, who are part of the Health Care Fraud Unit. Senior Trial Counsel Barbara Ward from the Bank Integrity, Recovery, and Money Laundering Unit also played a role in the prosecution.
Rivera’s sentencing is scheduled for June 26, 2025. He faces a maximum penalty of 10 years in prison and could also be fined up to $250,000 for his involvement in the scheme. While Rivera has admitted his part, the other nine individuals charged in the case are still presumed innocent until proven guilty in court.
This case serves as a reminder of how fraud can have far-reaching consequences, affecting not just companies like Amtrak, but also the employees and individuals who rely on the services. The authorities continue to pursue those involved in the scheme, ensuring that justice is served.
