Florida Man Convicted in $67 Million Medicare Fraud Scheme Targeting Unnecessary Genetic Tests

A Florida man, Jose Goyos, was convicted by a federal jury in Fort Pierce, Florida, for his involvement in a scheme to defraud Medicare of over $67 million. The scheme involved deceiving physicians into authorizing thousands of unnecessary genetic tests that were not used in the treatment of Medicare beneficiaries. Here are the key details:

• Jose Goyos, aged 37, managed a call center that engaged in deceptive telemarketing calls targeting Medicare beneficiaries and their physicians.
• Goyos oversaw the “doctor chase” division of the call center, which contacted the primary care physicians of Medicare beneficiaries and deceived them into ordering medically unnecessary genetic tests based on fraudulent medical paperwork.
• The call center falsely represented to providers that Medicare beneficiaries requested these genetic tests and had medical conditions justifying them, both of which were untrue.
• Goyos and his co-conspirators used these fraudulent authorizations to submit claims to Medicare for expensive and unnecessary genetic tests.
• The labs involved in the scheme were fraudulent shells with no equipment, did not conduct any tests, and had no lab personnel.
• The tests were often not sent to the Medicare beneficiaries’ primary care physicians and were not used in their treatment.
• Between June 2020 and July 2021, Goyos and his co-conspirators submitted over $67 million in false claims to Medicare, and Medicare paid over $52 million.
• Goyos was convicted of conspiracy to commit wire fraud and conspiracy to commit money laundering.
• He is scheduled to be sentenced on December 21 and faces a maximum penalty of 20 years in prison for the wire fraud conspiracy and 10 years in prison for the money laundering conspiracy.
• To date, 20 other defendants have pleaded guilty in the scheme, including its leaders.

This case highlights the efforts to combat healthcare fraud and protect Medicare from fraudulent claims.

The investigation was conducted by the FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG). The case is being prosecuted by the Criminal Division’s Fraud Section.

The Health Care Fraud Strike Force Program, comprising 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively billed federal health care programs and private insurers more than $24 billion since March 2007. The program aims to combat healthcare fraud.