Call Center "Doctor Chase" Manager Gets 15 Years in $67 Million Medicare Genetic Testing Fraud

The defendant and the sentence

According to DOJ, Jose Goyos, 38, of West Palm Beach, Florida, was sentenced to 15 years in prison for his role in a conspiracy to defraud Medicare by billing more than $67 million for medically unnecessary genetic testing. A jury convicted him in October 2023 of conspiracy to commit wire fraud and conspiracy to commit money laundering.

How the call center operated

According to court documents and trial evidence described by DOJ:

• Goyos worked at a call center that made deceptive telemarketing calls targeting thousands of Medicare beneficiaries and their physicians.
• He managed the "doctor chase" division, which contacted the primary care physicians of targeted beneficiaries.
• The division used medical paperwork the call center created to trick providers into ordering medically unnecessary genetic tests.
• Goyos directed employees to falsely tell providers that beneficiaries were "mutual patients" who had requested the tests and had conditions justifying them. Neither statement was true.
• The conspirators used the doctors' orders to bill Medicare. Test results often were not sent to the primary care physicians and were not used in treatment.

Between May 2020 and July 2021, the conspirators submitted more than $67 million in false claims, and Medicare paid more than $53 million.

Co-defendants

Nine other Florida residents previously were sentenced, including:

• Daniel M. Carver, 38, of Boca Raton: 16 years and eight months
• Thomas Dougherty, 42, of Palm Beach: 14 years
• John Paul Gosney Jr., 42, of Parkland: seven years and 11 months
• Galina Rozenberg and Michael Rozenberg of Hollywood: four years each
• Ethan Macier, Louis "Gino" Carver, Ashley Cigarroa and Timothy Richardson: two to just under four years each

The Federal Bureau of Investigation (FBI) and the Department of Health and Human Services Office of Inspector General (HHS-OIG) investigated. The Criminal Division's Fraud Section prosecuted the case, with the U.S. Attorney's Office for the Southern District of Florida handling asset forfeiture.

The bottom line:

Outbound calls to physicians, which were scripted to use false statements about mutual patients, drove a $67 million billing scheme. The manager who directed those statements received a 15 year sentence.

Key takeaways

1. Telemarketing to providers can be fraud when scripts contain false statements.
2. Call center managers face severe sentences, not only owners.
3. "Mutual patient" claims were the core deception in this script.
4. Money laundering counts accompany large health care telemarketing cases.
5. The Health Care Fraud Strike Force handled the case, through the Criminal Division's Fraud Section.