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Not less than 119 Amtrak workers and docs took the railroad firm for a trip in a large $12 million well being fraud scheme, a watchdog discovered.
Amtrak’s Workplace of Inspector Common (OIG) stated workers based mostly in Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut and Washington, D.C., accepted money kickbacks from three healthcare suppliers in alternate for the usage of their insurance coverage data and that of their dependents in a scheme from 2019 to 2022.
“The sheer quantity of workers who cavalierly participated on this scheme to steal Amtrak’s funds suggests not solely a severe lapse in fundamental ethics, however a troubling workforce tradition, not less than within the Northeast area, by which blatant legal habits was by some means normalized,” stated Amtrak Inspector Common Kevin H. Winters.
Fox Information Digital has reached out to Amtrak.
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Amtrak ran service between Chicago and Florida within the Nineteen Seventies. (Amtrak)
The healthcare suppliers used that worker data to file fraudulent and questionable medical claims for companies that have been by no means supplied or not medically crucial, the OIG stated. Total, the taxpayer-funded railroad provider’s well being plan was billed greater than $16 million and was bilked out of $12 million.
Of the 119 workers implicated, 28 retired or resigned because of the OIG’s investigation, and 30 left the corporate for “different causes.” One other dozen workers have been criminally charged, and 7 have pleaded responsible and are awaiting sentencing.
Sixty-one are nonetheless on the job.
In an announcement to Fox Information Digital, Amtrak stated it has taken “important steps” to deal with medical insurance coverage fraud.
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An Amtrak practice at Penn Station in New York Metropolis. (Getty Photographs)
“Like many employers, Amtrak calls on medical profit suppliers and insurers to do extra to establish suspicious exercise and cease medical insurance coverage fraud,” the corporate stated. “Amtrak strongly condemns this reprehensible act that occurred between 2019 and 2022 and is taking swift motion with all energetic workers concerned within the investigation.
“Whereas we proceed to work intently with the OIG to establish and stamp out fraud, we additionally proceed to work on different initiatives to deal with this difficulty,” the assertion added. “Amtrak has carried out varied measures to reinforce fraud prevention and empower workers to report suspected wrongdoing. These efforts embrace growing oversight and strengthening efforts to get rid of fraudulent schemes.”
Canceled trains are displayed on an Amtrak departures board in Moynihan Prepare Corridor at Penn Station in New York Dec. 23, 2024. (Yuki Iwamura/Bloomberg through Getty Photographs)
The OIG launched a probe when an agent observed uncommon billing patterns in experiences by information analysts. Three New York healthcare suppliers with “questionable” billings who shared a excessive variety of Amtrak workers as sufferers have been recognized by investigators.
An secret agent posing as an Amtrak worker met with Punson Figueroa, aka “Susie,” an acupuncturist from Lengthy Island Metropolis, New York, June 16, 2021. Throughout the go to, Figueroa informed the agent to signal his title 30 occasions for service with out courting the signatures, the OIG stated.
Figueroa then submitted alleged fraudulent claims to Amtrak’s healthcare plan, saying the agent had visited suppliers not less than seven occasions in Could 2021 for acupuncture and bodily remedy. The agent visited Figueroa’s workplace once more on July 29, 2021, the place she allegedly handed him an envelope containing $1,000.
Figueroa continued to make use of the agent’s insurance coverage data to submit dozens of fraudulent claims to Amtrak’s healthcare plan, investigators stated.
Figueroa pleaded responsible to defrauding Amtrak’s healthcare plan, was sentenced to a few years of supervised launch and was ordered to pay restitution of $9.05 million. Two different healthcare suppliers and a medical biller have additionally pleaded responsible for his or her roles within the scheme.
Authorities in North Tonawanda stated a Niagara-bound Amtrak practice struck a passenger car Could 17, 2024. (WKBW Buffalo)
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Michael DeNicola, a podiatrist from New York, pleaded responsible June 29, 2022, to conspiracy to commit well being care fraud, distribution of a managed substance and illegal possession of a gun. He has not but been sentenced.
Regina Choi, a medical biller from Woodside, New York, who beforehand labored for Figueroa, pleaded responsible to conspiracy to commit well being care fraud June 11, 2024, for submitting false and fraudulent claims to the Amtrak well being care plan and paying money kickbacks to Amtrak workers. Her sentence can also be pending.
In 2018 and 2019, OIG auditors issued separate experiences that stated Amtrak may strengthen measures to establish fraudulent medical claims sooner. Each experiences famous billing patterns indicative of potential fraud amongst a whole bunch of suppliers, the OIG stated.
