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Game Of Chase

Medicare_2-696x522
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

You know fraud is big when a business names a building floor after the crime. Goyos managed a Boca Raton, FL, call center, which employed about 50 to 70 people, to lead a telemarketing campaign whose whole purpose was to commit Medicare fraud. The department was called “Doctor Chase.” As in, it’s a game of chase. Chase the doctor and trick them for unnecessary fraudulent orders authorizing genetic tests. With this game, Goyos defrauded Medicare of over $67 million. And all the tests were completely unnecessary.

Goyos directed his employees to tell the physicians that the beneficiaries requested these genetic tests and that the beneficiaries had medical conditions to justify them. Of which neither statement was true. Goyos and his co-conspirators then used the doctors’ authorizations to submit claims to Medicare billed from companies he owned. In reality, the labs that Goyos used for billing Medicare were shells. They had no equipment. Not one single test was conducted. They didn’t even have lab personnel. And Goyos charged a premium. $7,000 per test. Goyos then referred all the genetic tests to other labs, which conducted them at a small fraction of the price that Goyos charged to Medicare. Twice billed by a fraudster. Twice paid by the U.S. taxpayer.

The greater shame is that after the tests were conducted, the results were almost never sent to the Medicare beneficiary’s primary care physicians, never to be used in any treatment of the beneficiary. A waste of resources all around.

On October 10, 2023, Goyos was found guilty of fraud and money laundering.

Great job by the Department of Health and Human Services in stopping this scheme.

Today’s Fraud of The Day is based on article “Florida call center manager bamboozled doctors in $67 million Medicare scam, jury says” published by Maimi Herald on October 11, 2023

Jose Goyos, 37, was convicted of conspiracy to commit wire fraud and conspiracy to commit money laundering in a Fort Pierce, Florida federal court on Oct. 10, 2023. Getty Images A West Palm Beach man has been convicted by a federal jury in a $67 million Medicare fraud scheme after the call center he managed tricked doctors of Medicare patients into approving thousands of expensive and medically unnecessary cardio genetic tests that weren’t used in the treatment of those who took them. Jose Goyos, 37, was found guilty of conspiracy to commit wire fraud and conspiracy to commit money laundering at a jury trial in Fort Pierce and now faces maximum penalties of 20 years in prison for the first charge and 10 for the second. However, he was acquitted of a healthcare fraud conspiracy and three related charges. He is scheduled to be sentenced Dec. 21.

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