Another defendant who was part of a multimillion-dollar healthcare fraud scheme tied to unnecessary genetic testing has been convicted by a federal jury.
Jose Goyos of West Palm Beach was indicted in February 2022 along with nine others in the Southern District of Florida for their alleged roles in a $67 million healthcare fraud, wire fraud, kickback, and money laundering scheme involving the submission of false and fraudulent claims.
Goyos, who was charged with conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to commit money laundering, and money laundering offenses, was convicted 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.
Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison. Conspiracy to pay and receive kickbacks is punishable by a maximum penalty of five years in prison.
The Genetic Testing Scheme
Goyos managed a call center that took part in deceptive telemarketing calls that targeted thousands of Medicare patients and their doctors.
According to evidence presented at trial, 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 them into ordering and authorizing medically unnecessary genetic tests based on medical paperwork that the call center created. The activities took place between January 2020 and July 2021.
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 tests, and had no lab personnel.
How the Scheme Worked
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, Goyos and his co-conspirators in this healthcare fraud scheme, submitted over $67 million of these false and fraudulent claims to Medicare, of which Medicare paid more than $52 million.
The Other Defendants
To date, 20 other defendants have pleaded guilty in the scheme to various charges, including the leaders of the scheme – Daniel M. Carver and his brother Daniel Carver. Daniel Carver pleaded guilty to conspiracy to commit healthcare fraud and wire fraud and conspiracy to defraud the United States and to pay and receive kickbacks. He faces up to 25 years in prison. Louis Carver pleaded guilty to conspiracy to commit healthcare fraud and faces up to 10 years in prison. Both are scheduled to be sentenced on December 5.
Thomas Dougherty of Royal Palm Beach, and John Paul Gosney Jr. of Parkland also have pleaded guilty and face sentencing in December.
Genetic Testing Fraud Focus of Investigations
Healthcare fraud involving genetic testing and durable medical equipment (DME) have become a focus for federal investigators in recent years. A Data Brief released by the U.S. Department of Health and Human Services Office of Inspector General found that between 2016 and 2019 Medicare payments for genetic tests quadrupled from $351 million to $1.41 billion, an increase of 302 percent.
Medicare Part B does not cover genetic tests used for predictive purposes. However, it does cover genetic tests used for diagnostic purposes under certain conditions.
The watchdog agency noted that “Although there are legitimate reasons that genetic testing has increased, these increases indicate areas of possible concern, such as excessive genetic testing and fraud, which may negatively affect beneficiaries.”
In 2020, CMS released a White Paper detailing why genetic testing has become ripe for fraud and abuse and providing examples of cases. Such tests can cost under $100 to several thousand dollars depending on the type and the complexity of the test, as well as payer policy.
In Need of Help?
The Health Law Offices of Anthony C. Vitale can provide compliance oversight services, assuring that your business relationships are compliant with all federal and state fraud, waste and abuse laws. The firm also represents healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others.
For more information you can contact the firm at 305-358-4500 or email@example.com.