{"id":54311,"date":"2023-10-10T11:08:05","date_gmt":"2023-10-10T18:08:05","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=54311"},"modified":"2023-10-10T11:08:49","modified_gmt":"2023-10-10T18:08:49","slug":"man-convicted-of-defrauding-medicare-of-67-million-by-tricking-physicians","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=54311","title":{"rendered":"Man Convicted of Defrauding Medicare of $67 Million By “Tricking” Physicians"},"content":{"rendered":"
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\"\"Officials announced Tuesday that a federal jury in Fort Pierce, Florida, convicted a man last week for his role in a scheme to defraud Medicare of over $67 million.<\/span><\/p>\n

Jose Goyos “tricked” physicians into authorizing thousands of unnecessary genetic tests that were not used in the treatment of the Medicare beneficiaries who took them, federal officials stated.<\/span><\/p>\n

The jury convicted Goyos of conspiracy to commit wire fraud and conspiracy to commit money laundering. He is scheduled to be sentenced on Dec. 21. <\/span><\/p>\n

\"gavel,Goyos faces a maximum penalty of 20 years in prison for the conspiracy to commit wire fraud count and ten years in prison for the scheme to commit money laundering count.<\/span><\/p>\n

Between June 2020 and July 2021, Goyos and his co-conspirators submitted over $67 million of these false and fraudulent claims to Medicare, of which Medicare paid over $52 million.<\/span><\/p>\n

To date, 20 other defendants have pleaded guilty in the scheme to various charges, including the leaders of the scheme \u2013 Daniel M. Carver, Thomas Dougherty, and John Paul Gosney Jr. \u2013 who are scheduled to be sentenced in December.<\/span><\/p>\n

\"\"According to court documents and evidence presented at trial, Goyos, 37, of West Palm Beach, managed a call center that engaged in deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians. <\/span><\/p>\n

Goyos and his co-conspirators managed the call center’s so-called \u201cdoctor chase\u201d division, which contacted the primary care physicians of targeted Medicare beneficiaries.<\/span><\/p>\n

Evidence indicated that they tricked these medical providers into ordering and authorizing medically unnecessary genetic tests based on medical paperwork that the call center created.<\/span><\/p>\n

\"\"For example, according to court documents, Goyos directed call center employees to falsely represent to providers that the Medicare beneficiaries were \u201cmutual patients\u201d who requested these genetic tests and that the beneficiaries had medical conditions justifying genetic testing when neither statement was true.\u00a0<\/span><\/p>\n

Goyos and his co-conspirators then used those doctors\u2019 authorizations to submit claims to Medicare for the expensive and unnecessary genetic tests.<\/span><\/p>\n

\"tuftedThe labs were shells; they had no equipment, did not conduct a single test, and had no lab personnel. <\/span><\/p>\n

Goyos and his co-conspirators referred all the genetic tests to other labs, which conducted them at a small fraction of the price that Goyos and his co-conspirators charged to Medicare. <\/span><\/p>\n

Finally, after the tests were conducted, the results often were not sent to the Medicare beneficiary\u2019s primary care physicians and were not used in the treatment of the beneficiary.<\/span><\/p>\n

Trial Attorneys Patrick J. Queenan, Reginald Cuyler Jr., and Andrew Tamayo of the Criminal Division\u2019s Fraud Section are prosecuting the case.<\/span><\/p>\n

The Fraud Section leads the Criminal Division\u2019s efforts to combat healthcare fraud through the Health Care Fraud Strike Force Program. <\/span><\/p>\n

Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. <\/span><\/p>\n

In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Health and Human Services Office of Inspector General, are taking steps to hold providers accountable for their involvement in healthcare fraud schemes. <\/span><\/p>\n

More information can be found at www.justice.gov\/criminal-fraud\/health-care-fraud-unit<\/a>.<\/span><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Officials announced Tuesday that a federal jury in Fort Pierce, Florida, convicted a man last week for his role in a scheme to defraud Medicare of over $67 million. 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