FORT PIERCE, Fla. — A West Palm Beach man was convicted Friday by a federal jury in Fort Pierce for his role in a scheme to defraud Medicare of more than $67 million.
The U.S. Department of Justice said the plot involved tricking physicians into authorizing thousands of genetic tests that were unnecessary and not used in the treatment of the Medicare beneficiaries who took them.
Prosecutors said Jose Goyos, 37, managed a call center that engaged in deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians.
They said Goyos and his co-conspirators managed a so-called "doctor chase" division of the call center, which contacted the primary care physicians of targeted Medicare beneficiaries and tricked these medical providers into ordering and authorizing medically unnecessary genetic tests based on medical paperwork that the call center created.
According to the DOJ, the scheme involved Goyos directing call center employees to falsely represent to providers that the Medicare beneficiaries were "mutual patients" who requested these genetic tests and that the beneficiaries had medical conditions justifying genetic testing — both of which were false.
Goyos and his co-conspirators then used those doctors' authorizations to submit claims to Medicare for the unnecessary genetic tests.
In reality, prosecutors said the labs were shells because they had no equipment, did not conduct a single test and had no lab personnel. The DOJ said Goyos and his co-conspirators referred all of the genetic tests to other labs, which conducted them at a fraction of the price that Goyos and his collaborators charged to Medicare.
Investigators said after the tests were conducted, the results often were not sent to the Medicare beneficiary's primary care physicians and were not used in the treatment of the beneficiary.
Between June 2020 and July 2021, the DOJ said Goyos and his co-conspirators submitted more than $67 million of these false and fraudulent claims to Medicare, of which Medicare paid more than $52 million.
The jury convicted Goyos of conspiracy to commit wire fraud and conspiracy to commit money laundering. He is scheduled to be sentenced on Dec. 21 and faces a maximum penalty of 20 years in prison for the conspiracy to commit wire fraud count and 10 years in prison for the conspiracy to commit money laundering count.
To date, prosecutors said 20 other defendants have pleaded guilty in the scheme to various charges, including Daniel M. Carver, Thomas Dougherty and John Paul Gosney Jr., who are scheduled to be sentenced in December.
