A federal jury in Fort Pierce, Florida, convicted a Florida man on Oct. 6 for his role in a scheme to defraud Medicare of over $67 million by tricking physicians into authorizing thousands of genetic tests that were completely unnecessary and not used in the treatment of the Medicare beneficiaries who took them.
According to court documents and evidence presented at trial, Jose Goyos, 37, of West Palm Beach, managed a call center that engaged in deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians. Goyos and his co-conspirators managed the so-called “doctor chase” division of the call center, which contacted the primary care physicians of targeted Medicare beneficiaries and tricked these medical providers into ordering and authorizing medically unnecessary genetic tests based on medical paperwork that the call center created. For example, Goyos directed call center employees to falsely represent to providers that the Medicare beneficiaries were “mutual patients” who requested these genetic tests, and that the beneficiaries had medical conditions justifying genetic testing, when neither statement was true.
Goyos and his co-conspirators then used those doctors’ authorizations to submit claims to Medicare for the expensive and unnecessary genetic tests. In reality, the labs were shells; they had no equipment, did not conduct a single test, and had no lab personnel. 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. Finally, after the tests were conducted, the results often were not sent to the Medicare beneficiary’s primary care physicians and were not used in the treatment of the beneficiary.
In total, 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.
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. He faces a maximum penalty of 20 years in prison for the conspiracy to commit wire fraud count and 10 years in prison for the conspiracy to commit money laundering count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
To date, 20 other defendants have pleaded guilty in the scheme to various charges, including the leaders of the scheme – Daniel M. Carver, Thomas Dougherty, and John Paul Gosney Jr. – who are scheduled to be sentenced in December.
Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division, Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division, and Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
The FBI and HHS-OIG investigated the case.
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. 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. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.
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