On October 10, the Department of Justice (DOJ) announced a Florida federal jury reached a verdict in a case involving Jose Goyos, a 37-year-old resident of West Palm Beach. Goyos was convicted of playing a significant role in a case that involved Medicare claims submitted between June 2020 and July 2021 amounting to over $67 million. 

The evidence presented at trial revolved around the operations of a call center that Goyos managed. The center was engaged in telemarketing activities that were subject to scrutiny. Goyos and his co-defendants were charged with overseeing the “doctor chase” division of the call center. Their role was to communicate with primary care physicians and assist in obtaining authorizations for genetic tests that were, according to the government’s perspective, medically unnecessary and not utilized in the treatment of Medicare beneficiaries.

Goyos was accused of providing information to physicians that did not accurately represent the patient’s situation. For example, the government accused Goyos of directing call center employees to falsely inform physicians that the Medicare beneficiaries themselves had requested the genetic tests and that they had specific medical conditions warranting such testing.

According to the government, Goyos used the authorizations obtained from physicians to submit claims to Medicare for these genetic tests. The laboratories tied to Goyos were labeled as “shells” because they had no testing equipment, conducted no tests, and employed no lab personnel. Instead, Goyos and his co-defendants outsourced these tests to other labs that reportedly conducted the tests at a significantly lower cost than what was charged to Medicare. Notably, the results of these tests were alleged not to have been sent to the Medicare beneficiaries’ primary care physicians and were not incorporated into the beneficiaries’ medical treatment.

A federal jury found Goyos guilty of conspiracy to commit wire fraud and conspiracy to commit money laundering. He is scheduled to be sentenced on December 21 and could potentially face a maximum penalty of 30 years in prison.

Healthcare professionals who utilize telehealth and telemedicine should remain vigilant regarding potential risks associated with fraud, waste, and abuse. This holds especially true when engaging with marketing agencies, lead generators, and call centers. 

Medicare fraud enforcement is showing no signs of slowing down.  Since its launch in March 2007, the DOJ’s Health Care Fraud Strike Force Program, which deploys 15 strike forces across 25 federal districts, has gone after more than 5,000 defendants. If you ever find yourself the target of an investigation, facing charges, or just wanting to ensure your practice is compliant, having a dedicated Medicare fraud defense team is vital.

The attorneys at Chilivis Grubman represent healthcare clients of all types and sizes in connection with government investigations (both criminal and civil) and regulatory matters, including matters involving the DOJ and HHS-OIG.  If you need assistance with such a matter, please contact us today.