Dec. 7 (UPI) — Jose Goyos of West Palm Beach, Fla., was sentenced Friday to 15 years in prison for conspiring to defraud Medicare of $67 million for medically unnecessary genetic testing.
Goyos, 38, worked at a call center that the Department of Justice says “engaged in deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians.”
He managed the call center’s “doctor chase” division that contacted primary care physicians who treated Medicare beneficiaries and tricked the doctors into ordering genetic testing that served no medical purpose, according to the DOJ.
The employees used medical paperwork that the call center created to falsely claim the Medicare beneficiaries were “mutual patients” who asked for genetic testing.
The call center also falsely claimed the patients were diagnosed with medical conditions that justified the genetic testing.
After obtaining the respective doctors’ orders for genetic testing, Goyos and his co-conspirators would submit claims for payment to Medicare.
The genetic tests were expensive, and the results seldom were shared with primary care physicians, the DOJ said.
The scheme generated more than $67 million in Medicare bills from May 2020 to July 2021, the DOJ said, and Medicare paid more than $53 million of that amount.
A federal jury in October 2023 found Goyos guilty of conspiring to commit wire fraud and money laundering.
Nine co-defendants from the Florida operation also were convicted and sentenced to between two years and more than 16 years in prison.