NEWARK, N.J. – A Georgia man will appear in court today for
his alleged role in a conspiracy to defraud federally funded and private health
care benefit programs by submitting fraudulent testing claims for COVID-19 and
genetic cancer screenings, U.S. Attorney Craig Carpenito announced.
Erik Santos, 49, of Braselton, Georgia, is charged by
complaint with one count of conspiring to violate the Anti-Kickback Statute and
one count of conspiring to commit health care fraud. He was arrested at his
home today by special agents of the FBI and is scheduled to have his initial
court appearance this afternoon before U.S. Magistrate Judge Alan J. Braverman
in Atlanta federal court.
“The complaint in this case describes a defendant who saw
the spread of COVID-19 as nothing more than an opportunity to profit
personally,” U.S. Attorney Carpenito said. “As the complaint alleges, he
offered kickbacks in exchange for medically unnecessary tests – including potentially
hard-to-obtain COVID-19 tests – thus preying on people’s fear in order to
defraud the government and make money for himself. The U.S. Attorney’s Office and our law
enforcement partners are focused on protecting the public from this kind of despicable
pandemic profiteering, and will act quickly to halt the fraud and bring the
perpetrators to justice.”
“It is unfortunate that we have people in our country who
will capitalize on others' suffering to make a buck,” Special Agent-in-Charge
Gregory W. Ehrie of FBI Newark said. “But this case takes things to a new low.
This defendant not only allegedly defrauded the government, he conspired to
bilk his fellow citizens of a valuable resource that's in high demand. His
profiteering is akin to receiving blood money. Throughout this challenging
crisis, the FBI remains on duty and vigilant in our efforts to capture anyone
who puts money before humanity."
“At a time when Americans are coming together in many
different ways to help our fellow citizens make it through this crisis, it is
unfathomable to think that some people, driven by personal greed, would try to
take advantage of people who need help the most,” Chris Hacker, Special Agent
in Charge of FBI Atlanta, said. “Though the FBI has had to adapt to doing
business in this trying time, we want to make it clear that we are continuing
to protect our citizens and uphold the Constitution.”
“Individuals seeking to fraudulently profit during the
COVID-19 global pandemic undermine the government's response, jeopardize
medical professionals and endanger the public,” Special Agent-in-Charge
Leigh-Alistair Barzey, Defense Criminal Investigative Service (DCIS), Northeast
Field Office, said. “The DCIS is committed to working with the U.S. Department
of Justice and its law enforcement partners to combat health care fraud and
protect TRICARE, the DoD's health care system, and the military members and
their families who depend upon it.”
According to documents filed in this case and statements
made in court:
Santos ran a marketing company that generated leads to
testing companies. From November 2019 through the present, Santos and others
engaged in a large-scale scheme to defraud Medicare by soliciting and receiving
kickback payments from companies involved in clinical and diagnostic testing in
exchange for steering to those companies individuals eligible for testing that
Medicare would reimburse. Medicare is a federally funded program to provide
medical insurance benefits for individuals 65 and older and certain disabled
individuals who qualify under the Social Security Act.
Santos agreed with others to be paid kickbacks on a per-test
basis for submitting genetic cancer screening tests to diagnostic testing
facilities, regardless of medical necessity. A genetic cancer screening is a
diagnostic tool that tests for a genetic predisposition to cancer. Santos’
scheme aimed to submit more than $1.1 million in fraudulent claims to Medicare.
Starting in February 2020, the effects of the COVID-19
pandemic began to be felt in the United States.
The virus is considered especially dangerous to patients over 65 – the
same population that is eligible for Medicare and TRICARE benefits. As cases
have increased in the United States, many individuals are reporting difficulty
obtaining tests to determine whether they were infected with the virus.
As the COVID-19 crisis began to escalate, Santos used the
pandemic as an opportunity to expand his pre-existing kickback schemes and to
capitalize on a national emergency for his own financial gain. Santos agreed
with others to be paid kickbacks on a per-test basis for COVID-19 tests,
provided that those tests were bundled with a much more expensive respiratory
pathogen panel (RPP) test, which does not identify or treat COVID-19. Santos
sought to maximize his kickback profits and to bleed federal health care
resources at a time when Medicare beneficiaries across the United States were
in dire need of coverage for medical treatment and services.
On March 19, 2020, Santos made the following statements in a
telephone call explaining that he viewed the pandemic as a money-making
opportunity:
• “[W]hile there are people going through what they are
going through, you can either go bankrupt or you can prosper.”
• “[T]he good thing is we’re opening a lot of doors through
this coronavirus testing.”
• Santos noted that his other work was on hold because
“everybody has been chasing the Covid dollar bird.”
The count of conspiracy to commit health care fraud carries
a maximum potential punishment of 10 years in prison; conspiracy to violate the
Anti-Kickback Statute carries a maximum potential penalty of five years in
prison. Both offenses are also punishable by a fine of $250,000, or twice the
gross gain or loss from the offense.
U.S. Attorney Carpenito credited special agents of the FBI,
under the direction of Special Agent in Charge Gregory W. Ehrie in Newark and
Special Agent in Charge Chris Hacker in Georgia; U.S. Department of Health and
Human Services, Office of Inspector General, under the direction of Special
Agent in Charge Scott J. Lampert; U.S. Department of Defense, Office of the Inspector
General, Defense Criminal Investigative Service, under the direction of Special
Agent in Charge Leigh-Alistair Barzey; U.S. Department of Veterans Affairs
Office of Inspector General, under the direction of Resident Agent in Charge
Christopher F. Algieri with the ongoing investigation leading to today’s
arrest.
To find more about Department of Justice resources and
information, please visit: www.justic.gov/coronavirus
The government is represented by Assistant U.S. Attorney
Sean M. Sherman of the U.S. Attorney’s Office’s Opioids Unit in Newark.
The charges and allegations contained in the complaint are
merely accusations, and the defendant is presumed innocent unless and until
proven guilty.
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