California Woman Pleads Guilty to COVID-19 Insurance Fraud Scheme Worth $359 Million

COVID-19 Insurance Fraud Guilty Plea

A California woman has entered a guilty plea for her involvement in a significant insurance fraud scheme related to COVID-19 testing.

The fraudulent scheme involved submitting claims to government and private insurance programs for medically unnecessary respiratory pathogen panel (RPP) tests during the pandemic.

Government Response to COVID-19 Insurance Fraud

U.S. Attorney General Merrick B. Garland emphasized the severity of defrauding government health programs during the pandemic, highlighting the Justice Department’s determination to hold those responsible accountable.

The action against this $359 million scheme is part of a broader effort to combat COVID-19-related fraud, with over 300 defendants and $830 million in alleged fraud recently announced by the Department.

Protecting the Healthcare System

FBI Director Christopher Wray emphasized the FBI’s commitment to protecting the healthcare system and ensuring accountability for those attempting to exploit it illegally.

He stressed the importance of coordination and collaboration with partners to prevent costly healthcare fraud schemes.

Details of the Fraudulent Scheme

According to court documents, Lourdes Navarro, in collaboration with Imran Shams, obtained nasal swab specimens under the pretext of COVID-19 screening tests.

However, these specimens were used for costly respiratory pathogen panel (RPP) tests, which were neither ordered nor medically justified.

The fraudulent claims, totaling approximately $359 million, were submitted to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company, resulting in reimbursements of around $54 million.

Consequences and Sentencing

Lourdes Navarro pleaded guilty to conspiracy to commit health care fraud and wire fraud. Her sentencing is scheduled for January 23, 2024, and she faces a maximum penalty of 20 years in prison.

Imran Shams has also pleaded guilty to conspiracy to commit health care fraud and is set to be sentenced on January 9, 2024.

Investigation and Prosecution

The case is being investigated by the FBI and HHS-OIG. Trial Attorneys Gary A. Winters and Raymond E. Beckering III of the Criminal Division’s Fraud Section are prosecuting the case. Assistant U.S. Attorney Maxwell Coll is handling forfeiture.

Health Care Fraud Strike Force Program

The Health Care Fraud Strike Force Program, led by the Fraud Section of the Criminal Division, has been actively combating health care fraud since 2007.

It has charged over 5,000 defendants who collectively billed Medicare for more than $24 billion. Additionally, Centers for Medicare & Medicaid Services and HHS-OIG are taking measures to hold providers accountable for involvement in health care fraud schemes.

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