A man from Florida was sentenced to 15 years in prison for his role in a huge scam that cheated Medicare out of more than $67 million. This scam involved tricking doctors and Medicare beneficiaries into paying for unnecessary genetic tests. The man, Jose Goyos, worked at a call center where employees used dishonest methods to get doctors to order these tests. This case is one of the largest health care fraud schemes ever uncovered, and it has led to multiple people being sentenced for their involvement.
The Fraudulent Scheme Led by Goyos
From May 2020 to July 2021, Goyos and others carried out a scheme to make Medicare pay for expensive tests that people didn’t need. Goyos was in charge of a department at the call center that focused on getting doctors to order these tests. The scammers used deceitful telemarketing calls to contact doctors. They tricked the doctors into thinking that the tests were necessary for their patients, even though the patients didn’t actually need them.
Goyos instructed the workers to tell doctors that the Medicare patients had requested genetic tests. In many cases, the workers claimed that the patients had medical conditions that made the tests necessary. However, these claims were false, and the tests were never actually needed for the patients’ health. The call center staff would then create fake medical paperwork to make everything appear legitimate.
After convincing the doctors to order the tests, the scammers would submit false claims to Medicare. Medicare, thinking the tests were needed, would pay out millions of dollars for these fake services. Over the course of the scam, Goyos and his team submitted over $67 million in fraudulent claims. Of this, Medicare ended up paying more than $53 million, even though the tests were unnecessary and often not used for the patients’ care.
How the Fraud Worked
The fraud involved several layers of dishonesty. First, the call center workers used high-pressure tactics to persuade doctors to order unnecessary tests. They told doctors that they were working with Medicare beneficiaries who needed these tests. They even went as far as saying that the patients had health conditions that made genetic testing important, though this was not true.
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Once the doctors ordered the tests, Goyos and his co-conspirators submitted these fake orders to Medicare. They created false paperwork to make the tests seem medically necessary. However, the results of the tests were often never sent to the patients’ doctors, and they were not used in any medical decisions. The whole process was designed to look legitimate, but it was all part of a plan to steal money from the Medicare program.
Medicare, trusting that the orders came from doctors who believed the tests were needed, paid out millions of dollars to cover the costs. The scam worked so well that it lasted for over a year, with millions of dollars flowing into the pockets of those involved. The criminals behind the scheme kept the money by laundering it through various methods, making it difficult to trace.
Sentences for the Conspirators
Goyos was convicted of conspiracy to commit wire fraud and money laundering in October 2023. He was sentenced to 15 years in prison for his involvement in the fraud. But he was not alone. Nine other people from Florida were also sentenced for their roles in the scheme. Some received long prison sentences, while others were given shorter sentences, ranging from just over two years to over 16 years.
These individuals were all involved in different parts of the scam. Some made the fake calls to doctors, while others handled the paperwork and submitted the fraudulent claims. Many of them, like Goyos, played key roles in making the scam work. The government has now successfully convicted many of those who were responsible, sending a strong message about the consequences of health care fraud.
The case was investigated by the FBI and the Department of Health and Human Services (HHS). Prosecutors worked hard to bring these criminals to justice. The work of these agencies is crucial in fighting health care fraud, which costs the government billions of dollars every year.
This case highlights the dangers of fraud in health care and the need for strong oversight to protect programs like Medicare. The people involved in this scheme thought they could get away with stealing millions, but thanks to the efforts of law enforcement, they are now facing serious consequences.
