Federal prosecutors said the alleged scheme involved billing Medicare for reimbursable medical tests regardless of whether they were medically necessary.
Federal prosecutors Monday charged a 49-year-old man from Braselton, Georgia, who allegedly engineered a broad scheme to fraudulently cash in on the novel coronavirus pandemic.
Erik Santos is set to appear before a judge in Atlanta’s federal court Monday afternoon, regarding his “alleged role in a conspiracy to defraud federally funded and private health care benefit programs by submitting fraudulent testing claims for COVID-19 and genetic cancer screenings,” according to a statement from the Justice Department’s U.S. Attorney’s Office for the District of New Jersey.
Santos faces one count of conspiring to violate the Anti-Kickback Statute and one count of conspiring to commit health care fraud.
“The complaint in this case describes a defendant who saw the spread of COVID-19 as nothing more than an opportunity to profit personally,” U.S. Attorney Craig Carpenito wrote in the announcement. “[Santos] offered kickbacks in exchange for medically unnecessary tests—including potentially hard-to-obtain COVID-19 tests—thus preying on people’s fear in order to defraud the government and make money for himself.”
In the release and associated complaint documents, authorities note that Santos led a marketing business that generated leads to medical testing companies. The announcement said since roughly November 2019, “Santos and others engaged in a large-scale scheme to defraud Medicare by soliciting and receiving kickback payments from companies involved in clinical and diagnostic testing in exchange for steering to those companies individuals eligible for testing that Medicare would reimburse.”
Officials noted that Santos agreed with others involved “to be paid kickbacks on a per-test basis for submitting genetic cancer screening tests to diagnostic testing facilities, regardless of medical necessity.” Through that scheme, Santos ultimately sought to “submit more than $1.1 million in fraudulent claims to Medicare,” authorities said.
Not long after COVID-19’s initial disruption in America, authorities said Santos saw the opportunity to capitalize on the crisis to pocket more money out of his existing kickback schemes.
“Santos agreed with others to be paid kickbacks on a per-test basis for COVID-19 tests, provided that those tests were bundled with a much more expensive respiratory pathogen panel test, which does not identify or treat COVID-19,” the announcement said. “[He] sought to maximize his kickback profits and to bleed federal health care resources at a time when Medicare beneficiaries across the United States were in dire need of coverage for medical treatment and services.”
Officials also shared recent statements from Santos that they said indicate his view of the pandemic as “a money-making opportunity.” On a March 19 telephone call, they noted Santos said that his company’s regular efforts were on hold because “‘everybody has been chasing the Covid dollar bird,’” and that “‘while there are people going through what they are going through, you can either go bankrupt or you can prosper.’”
If Santos is convicted on both counts, he could spend up to 15 years in prison.
This announcement comes only a week after the Justice Department unveiled it filed its first enforcement action against fraud related to COVID-19. It also follows a range of other scam-focused warnings launched by other federal agencies.
Justice’s Carpenito noted in the announcement that the department and its law enforcement partners “are focused on protecting the public from this kind of despicable pandemic profiteering, and will act quickly to halt the fraud and bring the perpetrators to justice.”