NEWARK, N.J. — The FBI arrested a man in Gwinnett County on charges related to an alleged conspiracy to defund health care benefit programs by submitting fake testing claims for COVID-19 and genetic cancer screenings.
Erik Santos, 49, of Braselton is charged with one count of conspiring to violate the Anti-Kickback Statute and one count of conspiring to commit health care fraud. FBI special agents arrested him at his home Monday morning and he was expected to have his first appearance in an Atlanta federal court before U.S. Magistrate Judge Alan J. Braverman later in the day.
“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 Craig Carpenito of New Jersey 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.”
Court documents indicate Santos ran a marketing company that generated leads to testing companies. Between November and March, he and others allegedly engaged in a 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.
The government alleged Santos and others agreed to be paid kickbacks on a per-test basis for submitting genetic cancer screening tests to diagnostic testing facilities regardless of medical need. A genetic cancer screening is a diagnostic tool that tests for a genetic predisposition to cancer. The scheme aimed to submit more than $1.1 million in fraudulent claims to Medicare.
As the effects of the coronavirus outbreak began to hit the U.S. in February, Santos allegedly agreed with others to be paid kickbacks on a per-test basis for COVID-19 tests, provided they were bundled with a more expensive respiratory pathogen panel test, which does not identify or treat COVID-19.
The U.S. attorney’s office in Newark reported that Santos, ina March 19 telephone call, described the pandemic as a money-making opportunity, saying that while people go through it, “you can either go bankrupt or you can prosper.”
“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, the 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.”
Conspiracy to commit health care fraud carries up to 10 years in prison, and conspiracy to violate the Anti-Kickback Statute carries up to five years in prison. Each has fines of up to $250,000, or twice the gross gain or loss from the offense.
