NEWARK, New Jersey. Three men and one woman were arrested today for participating in a health care fraud scheme to defraud Amtrak by bribing Amtrak employees so people can file fraudulent claims with Amtrak’s health insurance plan, U.S. Attorney Philip R. Sellinger said.
Muhammad Mirza, 50, from Cedar Grove, New Jersey; Devon Burt, 49, from Blue Bell, Pennsylvania; and Hallum Gelzer, 43, of East Orange, New Jersey, were charged with conspiracy to commit health care fraud in Newark federal court. Panson Figueroa, also known as “Susie Figueroa”, 55, of Long Island City, New York, was indicted in the same complaint for 15 counts of health care fraud. The defendants appeared via videoconference before U.S. Justice of the Peace James B. Clark III today and were released on $200,000 unsecured bail.
According to the documents presented in the case and statements made in court:
From 2019 to the present, Mirza, Figueroa, Gelser, Bert and others have been recruiting Amtrak employees—mostly from New Jersey and New York—to participate in the scheme, offering cash payments in exchange for employees agreeing to allow Mirza, Figueroa and others to use information about patients and insurance companies to file fraudulent claims. Mirza, Figueroa, and others benefited from the scheme by receiving payments from the Amtrak health plan for services that were never provided or were not medically needed. Gelzer, Bert, and others profited from the scheme by receiving cash payments from vendors in exchange for allowing those vendors to use their personal and insurance information to file fraudulent claims and in exchange 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 told the undercover agent that the undercover agent had good insurance and that Amtrak had very good benefits. Figueroa filed or caused false statements to Amtrak’s health plan indicating that an undercover agent visited providers at least seven times in May 2021, allegedly receiving acupuncture and physical therapy services.
The undercover agent visited Figueroa’s office only once, 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 file fraudulent claims with the Amtrak health plan, for a total of 73 claims. As a result of these fraudulent claims, Amtrak’s health plan paid out $31,840.
In total, Amtrak’s health care plan paid out at least approximately $9 million as a result of provider-related claims associated with the healthcare fraud scheme.
Each charge of health care conspiracy and fraud carries a maximum potential penalty of 10 years in prison and a $250,000 fine or twice the gross profit or loss of the crime, whichever is greater.
U.S. Attorney Sellinger enlisted Amtrak’s Office of the Inspector General’s Office of Special Agents under Special Agent in Charge Michael J. Waters; DEA Special Agents under Special Agent in Charge Frank A. Tarentino III; FBI Special Agents under Assistant Director Michael J. Driscoll; the U.S. Food and Drug Administration Criminal Investigation Division under Acting Special Agent Bradley Greenberg; US Postal Inspection Service Postal Inspectors under Chief Postal Inspector Damon Wood, Philadelphia Division; and the Amtrak Police Department under Police Chief Samuel Dotson with an investigation leading to the indictments.
The government is represented by Assistant U.S. Attorney Katherine Romano of the Newark Health Fraud Unit and Daniel W. Shapiro, Deputy Chief of Criminal Division.
The accusations and allegations contained in the complaint are simply accusations and the defendants are presumed innocent until proven guilty.