Florida call center manager bamboozled doctors in $67 million Medicare scam, jury says
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.
According to the court documents, Goyos managed a Boca Raton call center, which employed 50 to 70 people, to lead a deceptive telemarketing campaign targeting thousands of Medicare beneficiaries and their doctors between June 2020 and July 2021. The scheme was carried out at the outset of the COVID-19 pandemic, when federal authorities made it easier for patients in urban, not just rural, areas to receive telemedicine evaluations.
Goyos directed his employees to tell the physicians that the beneficiaries requested these genetic tests and had medical conditions justifying them, when neither statement was true, the U.S. Department of Justice said Monday in a news release.
“Goyos and his co-conspirators then used those doctors’ authorizations to submit claims to Medicare for the expensive and unnecessary genetic tests,” the Justice Department said. “In reality, the labs were shells; they had no equipment, did not conduct a single test, and had no lab personnel.”
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The defendant and his co-conspirators then referred all the genetic tests to other labs, which charged considerably less than the $7,000 per test billed to the tax-payer funded Medicare insurance program, according to the Justice Department and court documents.
“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,” the Justice Department said. “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.”
The conspirators used shell companies MDA CONSUMERS, H Town Group and Eighteen Group, based in Boca Raton, North Miami Beach and Hollywood respectively, to launder funds from the scheme, according to the court documents.
In a year, the Department of Justice says Goyos and his co-conspirators submitted over $67 million of these false and fraudulent claims, of which Medicare paid over $52 million.
Goyos was convicted Oct. 6 in Fort Pierce federal court.
To date, 20 other defendants have pleaded guilty 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.
The FBI and the Office of Inspector General of the U.S. Department of Health and Human Services investigated the case.
Since March 2007, the Department of Justice’s Health Care Fraud Strike Force Program has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion.
Miami Herald staff writer Jay Weaver contributed to this report.
