A Florida man was sentenced to 15 years in prison for his role in a wide-ranging conspiracy to defraud Medicare by billing over $67 million for medically unnecessary genetic testing. According to court documents and evidence presented at trial, Jose Goyos, 38, of West Palm Beach, was employed at a call center that engaged in deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians. Goyos managed the 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 medically unnecessary genetic tests based on medical paperwork that the call center created. For example, Goyos directed call center employees to falsely represent to providers that the Medicare beneficiaries were “mutual patients” who had requested these genetic tests and that the beneficiaries had medical conditions justifying genetic testing, when neither statement was true.
Goyos and his co-conspirators then used those doctors’ orders to submit claims to Medicare for expensive and medically unnecessary genetic tests. The results of these tests often were not sent to the Medicare beneficiaries’ primary care physicians and were not used in the treatment of the beneficiaries. In total, between May 2020 and July 2021, Goyos and his co-conspirators submitted over $67 million in false and fraudulent claims to Medicare, of which Medicare paid over $53 million.
