Four people charged with multimillion-dollar healthcare fraud for defrauding Amtrak | USAO-NJ

NEWARK, NJ — Three men and one woman were arrested today for participating in a healthcare fraud scheme to defraud Amtrak by bribing Amtrak employees to allow people to make fraudulent applications to the Amtrak health insurance plan , announced US Attorney Philip R. Sellinger.

Muhammad Mirza, 50, of Cedar Grove, New Jersey; Devon Burt, 49, of Blue Bell, Pennsylvania; and Hallum Gelzer, 43, of East Orange, New Jersey, were charged in federal court in Newark with conspiracy to commit healthcare fraud. Punson Figueroa, aka “Susie Figueroa”, 55, of Long Island City, New York, was charged with 15 counts of healthcare fraud in the same complaint. The defendants appeared before US Judge James B. Clark III via videoconference today and were released on $200,000 unsecured bail.

According to the documents and testimonies filed in court in this case:

From 2019 to the present, Mirza, Figueroa, Gelzer, Burt and other Amtrak employees — primarily from New Jersey and New York — recruited for participation in the program by offering cash payments in exchange for the employees’ approval to allow Mirza to recruit Figueroa and others to use their patient and insurance information to submit fraudulent claims. Mirza, Figueroa and others benefited from this program by receiving payments from the Amtrak healthcare plan for services that were never performed or that were medically unnecessary. Gelzer, Burt, and others benefited from this program by receiving cash payments from vendors in exchange for allowing those vendors to use their personal and insurance information to submit fraudulent claims, and in exchange for allowing others to participate recruited into the program.

On June 17, 2021, an undercover law enforcement officer posing as an Amtrak employee met with Figueroa at Figueroa’s New York office. Figueroa instructed the undercover agent to sign his name about 30 times for services received and instructed the undercover agent not to date the signatures. Figueroa explained to the informant that the informant has good insurance and that Amtrak has very good benefits. Figueroa submitted, or had submitted, false allegations to Amtrak’s healthcare plan that the undercover cop had visited healthcare providers at least seven times in May 2021 and allegedly used acupuncture and physical therapy services.

The undercover agent only visited Figueroa’s office once more, on July 29, 2021. At that meeting, which was recorded on audio and video, Figueroa presented the undercover agent with an envelope containing $1,000. Figueroa continued to use the undercover cop’s personal and insurance information to make fraudulent applications to the Amtrak health plan, totaling 73 applications. As a result of these fraudulent claims, the Amtrak health plan paid $31,840.

In total, the Amtrak Healthcare Plan has paid at least approximately $9 million as a result of claims related to providers associated with the healthcare fraud scheme.

The charges of conspiracy and healthcare fraud each carry a potential maximum sentence of 10 years in prison and a fine of $250,000 or twice the gross profit or loss from the offense, whichever is greater.

U.S. Attorney Sellinger attributed special agents from the Amtrak Office of Inspector General, headed by Special Agent-in-Charge Michael J. Waters; Special Agents of the Drug Enforcement Administration under the direction of Special Agent in Charge Frank A. Tarentino III; FBI special agents under the direction of Deputy Acting Director Michael J. Driscoll; the US Food and Drug Administration Office of Criminal Investigations, headed by Acting Special Agent in Charge Bradley Greenberg; US Postal Inspection Service postal inspectors headed by Postal Inspector in Charge Damon Wood, Philadelphia Division; and the Amtrak Police Department, led by Police Commissioner Samuel Dotson, with the investigation leading to the indictments.

The government is represented by Assistant US Attorney Katherine Romano of the Health Care Fraud Unit in Newark and Daniel V. Shapiro, Deputy Chief of Crime.

The allegations and allegations contained in the Complaint are allegations only and the accused are presumed innocent until proven guilty.

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