Four People Charged in Multimillion-Dollar Health Care Fraud Scheme to Defraud Amtrak
NEWARK, N.J. – Three men and one woman were arrested today for participating in a health care fraud scheme to defraud Amtrak by bribing Amtrak employees to allow people to submit fraudulent claims to the Amtrak health insurance plan, U.S. Attorney Philip R. Sellinger announced.
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 by complaint with conspiracy to commit health care fraud in Newark federal court. Punson Figueroa, aka “Susie Figueroa,” 55, of Long Island City, New York, was charged in the same complaint with 15 counts of health care fraud. The defendants appeared by videoconference today before U.S. Magistrate Judge James B. Clark III and were released on $200,000 unsecured bond.
According to documents filed in this case and statements made in court:
From 2019 to the present, Mirza, Figueroa, Gelzer, Burt, and others recruited Amtrak employees – primarily from New Jersey and New York – to participate in the scheme through the offer of cash payments, in exchange for the employees agreeing to allow Mirza, Figueroa, and others to use their patient and insurance information to submit fraudulent claims. Mirza, Figueroa, and others benefitted from this scheme by receiving payments from the Amtrak health care plan for services that were never provided or that were medically unnecessary. Gelzer, Burt, and others benefitted from this scheme by receiving cash payments from providers in return for allowing those providers to use their personal and insurance information to submit fraudulent claims and in return for recruiting others to participate in the scheme.
On June 17, 2021, an undercover law enforcement agent posing as an Amtrak employee met with Figueroa at Figueroa’s office in New York. 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 stated to the undercover agent that the undercover agent had good insurance, and that Amtrak has very good benefits. Figueroa submitted or caused to be submitted false claims to Amtrak’s health care plan indicating that the undercover agent had visited providers at least seven times in May 2021, purportedly receiving acupuncture and physical therapy services.
The undercover agent visited Figueroa’s office on only one other occasion, on July 29, 2021. At this meeting, which was recorded on audio and video, Figueroa handed the undercover agent an envelope filled with $1,000. Figueroa continued to use the undercover agent’s personal and insurance information to submit fraudulent claims to the Amtrak health care plan, for a total of 73 claims. As a result of these fraudulent claims, the Amtrak health care plan paid $31,840.
In total, the Amtrak health care plan has paid at least approximately $9 million as a result of claims associated with providers connected to the health care fraud scheme.
The conspiracy and health care fraud charges each carry a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest.
U.S. Attorney Sellinger credited special agents of the Amtrak Office of Inspector General, under the direction of 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; special agents of the FBI, under the direction of Assistant Director in Charge Michael J. Driscoll; the U.S. Food and Drug Administration Office of Criminal Investigations, under the direction of Acting Special Agent in Charge Bradley Greenberg; postal inspectors of the U.S. Postal Inspection Service, under the direction of Postal Inspector in Charge Damon Wood, Philadelphia Division; and the Amtrak Police Department, under the direction of Chief of Police Samuel Dotson, with the investigation, leading to the charges.
The government is represented by Assistant U.S. Attorney Katherine Romano of the Health Care Fraud Unit in Newark and Daniel V. Shapiro, Deputy Chief of the Criminal Division.
The charges and allegations contained in the complaint are merely accusations, and the defendants are presumed innocent unless and until proven guilty.