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Amtrak ties 119 workers to health care fraud

Inspector general says they got kickbacks from providers for false claims

By: Amanda Wallace
NorthJersey.com
USA Today Network - New Jersey

..... At least 119 Amtrak employees conspired with health care providers in New York to bilk the company's health care plan of more than $12 million between 2019 and 2022. Amtrak's Office of Inspector General said May 7. [2025]
..... On May 6, [2025] the OIG issued an investigative report to Amtrak detailing this widespread scheme.
..... The report said the involved employees who were based in Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut and Washington, D.C., accepted cash kickbacks from three health care providers in exchange for the sue of there insurance information, as well as that of their dependents in some cases. The health care providers sued the employees' information to file "fraudulent and questionable medical claims" for services that either were never provided or were not medically necessary.
..... In total, the OIG said, Amtrak's health care plan was billed more than $16 million and paid out more than $12 million during this scheme.
..... "Amtrak strongly condemns this reprehensible act that occurred between 2019 and 2022 and is taking swift action with all active employees involved in the investigation," Amtrak spokesperson Olivia Irvin said in an emailed statement.
..... "The sheer volume of employees who cavalierly participated in this scheme to steal Amtrak's funds suggest not only a serious lapse in basic ethics, but a troubling workforce culture, at least in the Northeast region, in which blatant criminal behavior was somehow normalized," said Amtrak Inspector General Kevin H. Winters, who added that this case represents the largest employee conspiracy that his office has ever investigated.
..... The investigation began after an OIG agent noticed "unusual billing patterns" in reports form the office's data analysts. Upon further review, the analysts identified three New York health care providers with "questionable billings." These providers also shared a high number of Amtrak employees as patients, the OIG said. Simultaneously, agents were gathering physical evidence that linked Amtrak employees to providers and the scheme.
..... On June 16, 2021, an undercover law enforcement agent met with Punson Figueroa, aka "Susie," an acupuncturist from Long Island City, New York. during the visit to Figueroa;s office, she instructed the agent, who was posing as an Amtrak employee, to sign his name about 30 times for services received, without dating the signatures.
..... Figueroa then submitted fraudulent claims to Amtrak's health care plan, the OIG said. It said she falsely indicated that the agent visited providers at least seven times for acupuncture and physical therapy in May 2021.
..... On July 29, 2021, the agent visited Figueroa's office again, and she gave him an envelope nonstaining $1,000, the OIG said. After that, she continued to sue th agent's insurance information, submitting dozens of fraudulent claims to the company's health care plans, the OIG reported.
..... Figueroa, tow other health care providers and a medical biller have all since pleaded guilty for there parts in this scheme, the Amtrak office said. Figueroa was sentenced on September 24, 2024, to three years of supervised release and was ordered to pay restitution of $9.05 million.
..... Among the other three people involved is Muhammad Mirza, a medical doctor from New Jersey, who was sentenced on May 7, 2024, to 26 months in prison and was order to pay restitution of $1.37 million.
..... As a result of the OIG's investigation, 28 Amtrak employees have retired or resigned and 30 have left the company for other reason, the announcement said. A dozen employees have been criminally charged in the case, with seven pleading guilty, pending sentencing. The office's findings on the 61 remaining active employees were given to Amtrak for "consideration of appropriate administrative disciplinary actions."
..... One former Amtrak employee, Devon Bute of Blue Bell, Pennsylvania, and a co-conspirator, Hallum Gelzeer of East Orange, worked with health care providers to recruit Amtrak employees to participate in the scheme, the OIG said. They separately pleaded guilty in June 2023 to charges of conspiracy to commit health care fraud and conspiracy to communicate extortionate threat.
..... The OIG said Burt agreed to pay $959,072 and Gelzer agreed to pay more than $1.6 million in restitution. They also admitted to threatening injury to a health care provider unless Gelzer was paid several thousand dollars.
..... Six other employees, including three from New Jersey, have also pleaded guilty to health care fraud conspiracy charges.
..... "We hope this investigation and the resulting accountability process serves as a deterrent for Amtrak employees and health care providers who may choose to engage in such schemes, and we ask anyone who suspects or observes such fraud to report it to our fraud, waste and abuse hot-line," said Winters, the inspector general.
..... In addition to its investigation, his office's auditors said in 2018 and 2019 reports that Amtrak could "strengthen controls to better identify fraudulent medical claims sooner." am track addressed the OIG's recommendations in the 2018 report, but two recommendations for the 2019 report remain open, the office said. Additionally, the OIG recently identified health care fraud as one of four high-risk areas in a report of fraud risk that Amtrak could face as it leverage federal investments.
..... Amtrak's emailed statement said the company is working closely with the OIG to "identify and stamp out fraud."
..... Various measures have been implemented to enhance fraud prevention and encourage employees to report suspected wrongdoing.
..... These measures include employee education, monitoring claims, and enrolling employees in more cost-efficient helaht care plans.
..... "These efforts Aime to create a robust system to detect and prevent fraudulent activities, helping ensure that Amtrak's health care plans are protected from abuse and inefficiencies," read the company's statement.
..... "Unfortunately, bad actors continue to test opportunities to steal from Amtrak, and we will continue to work with the OIG to be sure that employees and medical providers who engage in these activities are brought ti justice. We are proud to work closely with the OIG as we continually aim to improve efficiency and effectiveness; prevent and detect fraud; and provide congress with timely information relating to Amtrak's programs and operations."

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