At least 119 Amtrak staff and medical doctors have been taken to the railroad firm and boarded a $12 million well being fraud scheme.
The Amtrak Inspector’s Office (OIG) mentioned the worker, based mostly in Pennsylvania, New Jersey, New York, Maryland, Connecticut and Washington, D.C., has accepted money kickbacks from three well being care suppliers in alternate for insurance coverage info and use of dependents within the 2019-2022 scheme.
“The huge quantity of staff who’ve joined the scheme vigorously to steal Amtrak’s funds suggests not solely a critical course of fundamental ethics, but additionally a troubling workforce tradition within the Northeast area the place blatant prison exercise is by some means normalized.”
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Amtrak operated companies between Chicago and Florida within the Nineteen Seventies. (Amtrak)
Healthcare suppliers will use their worker info to file fraudulent and suspicious medical claims for companies that aren’t supplied or usually are not medically vital, OIG mentioned. Overall, taxpayer-funded rail provider well being plans have been billed over $16 million and eliminated inside $12 million.
Of the 119 staff, 28 have retired or resigned because of an OIG investigation, and 30 have left the corporate for “different causes.” Dozens extra staff have been charged with prison expenses, seven pleading responsible and awaiting sentence.
61 individuals are nonetheless at work.
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Amtrak prepare situated at Penn Station in New York City. (Getty Images)
“Like many employers, Amtrak is urging well being advantages suppliers and insurance coverage firms to do extra to establish suspicious exercise and to cease medical health insurance fraud,” the corporate mentioned. “Amtrak is strongly condemning this rebukeable act that occurred between 2019 and 2022 and is taking immediate motion with all lively staff concerned within the investigation.
“We’re working intently with OIG to establish and impose fraud, however we’re persevering with to work on different initiatives to deal with this problem,” the assertion added. “Amtrak has applied a wide range of measures to boost fraud prevention and allow staff to report suspected fraud. These efforts embody rising surveillance and strengthening efforts to get rid of fraudulent schemes.”
The cancelled prepare can be on show on the Amtrak Departure Committee, situated in Moynihan Train Hall, New York’s Penn Station, on December 23, 2024.
OIG began probes when the agent seen an uncommon billing sample within the report by information analysts. Three New York healthcare suppliers with “suspecting” claims that shared many Amtrak staff as sufferers have been recognized by investigators.
On June 16, 2021, a undercover agent pretending to be an Amtrak worker met with “Sussy,” acupuncture cup artist from Long Island City, New York, aka “Sussy.”
Figueroa then filed a fraudulent declare with Amtrak’s Health Care Plan, saying that in May 2021, the agent visited the supplier a minimum of seven instances for acupuncture and bodily remedy. The agent visited Figueroa’s workplace once more on July 29, 2021, the place she allegedly gave him an envelope containing $1,000.
Figueroa continues to file quite a few fraudulent claims with Amtrak’s healthcare plan utilizing its agent’s insurance coverage info, investigators mentioned.
Figueroa pleaded responsible to fraudulent Amtrak’s well being care plan, and was sentenced to a few years of supervised launch and ordered to pay $9.05 million in reparations. Two different healthcare suppliers and medical claimants have additionally pleaded responsible to their function within the scheme.
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Michael Dennicola, a podiatrist from New York, pleaded responsible on June 29, 2022 to conspiracy to commit well being care fraud, distribution of managed substances and unlawful possession of a gun. He has not been declared but.
Regina Che, a medical invoice in Woodside, New York, beforehand labored for Figueroa, admitted to a conspiracy to commit well being care fraud on June 11, 2024, filed a false fraudulent declare with the Amtrak Healthcare Plan and paid money kickbacks to Amtrak staff. Her sentence can be pending.
In 2018 and 2019, OIG auditors issued separate studies stating that Amtrak might step up its measures to establish fraudulent medical claims quicker. Both studies targeted on billing patterns that exhibit potential fraud amongst a whole lot of suppliers, OIG mentioned.