Florida Telemarketer Sentenced to 15 Years in Prison for $67 Million Medicare Fraud Scheme

Florida Telemarketer Sentenced to 15 Years in Prison for $67 Million Medicare Fraud Scheme

On December 6, Jose Goyos was sentenced to 15 years in prison for his role in managing a deceptive telemarketing scheme to defraud Medicare of over $67 million for medically unnecessary genetic testing. He had been convicted of conspiracy to commit wire fraud and conspiracy to commit money laundering.

Goyos managed a “doctor chase” division of a call center, which contacted primary care physicians of targeted Medicare beneficiaries and deceived the physicians into ordering medically unnecessary genetic tests based on false medical paperwork the call center created. Goyos instructed call center employees to falsely represent to the physicians that the Medicare beneficiaries were “mutual patients” who requested the genetic tests and had medical conditions justifying the tests. The call center then used the physicians’ authorizations to submit claims to Medicare for unnecessary genetic tests. The call center had no equipment, did not conduct any tests, and had no lab personnel. Rather, the call center referred all tests to other labs. Often, test results were not sent to the physicians or used in the treatment of the Medicare beneficiary.

Between May 2020 and July 2021, the call center submitted over $67 million in fraudulent claims to Medicare, of which Medicare paid over $53 million. Nine other Florida residents were previously sentenced for their roles in this conspiracy.

The US Department of Justice’s (DOJ) press release can be found here.

Two Biotech Executives Convicted of Securities Fraud for False Statements Regarding FDA Submissions

Nader Pourhassan and Kazem Kazempour were convicted on December 9, by a federal jury in Maryland for engaging in securities fraud related to CytoDyn Inc., a publicly traded biotechnology company based in Washington. Pourhassan was CytoDyn’s CEO, and Kazempour was the CEO of a research organization hired by Cytodyn to conduct clinical trials and serve as CytoDyn’s representative with the US Food and Drug Administration (FDA). The pair were convicted of securities fraud, wire fraud, and insider trading for their roles in deceiving investors regarding CytoDyn’s regulatory submissions to the FDA. Kazempour and Pourhassan lied to investors to artificially inflate CyntoDyn’s stock price and attract new investors.

The two individuals made false and misleading statements to CytoDyn’s investors regarding the company’s FDA application for a drug as a potential treatment for Human Immunodeficiency Virus. In spring of 2020, they falsely stated that a complete application was submitted even though they knew that the submitted application was incomplete and would not be reviewed by the FDA. After the announcement, Pourhassan sold over 4.8 million shares of CytoDyn based on material non-public information.

Pourhassan also made false and misleading statements regarding CytoDyn’s investigation and development of a drug called leronlimab as a potential treatment for COVID-19. He made statements regarding the results and significance of clinical trials for the drug and likelihood of approval by the FDA, though he knew that the clinical studies had failed and the FDA had expressed concerns that the submitted data was misleading.

During their scheme, Pourhassan received $4.4 million and Kazempour received over $340,000 from their sales of CytoDyn stock. Additionally, CytoDyn raised approximately $300 million from investors, of which over $22 million was paid to Kazempour’s research company.

The DOJ’s press release can be found here.

Neurologist Pays Over $900,000 to Settle Alleged False Medicare Claims for Implants

Texas neurologist and pain medicine physician Dr. Basem Hamid agreed to pay $948,359.85 to resolve allegations that he submitted false claims to Medicare for surgical implantation of neurostimulator electrodes. These invasive procedures usually require use of an operating room and are reimbursed by Medicare for thousands of dollars per procedure. Hamid billed Medicare for these procedures from 2019 to 2022, but according to the allegations, neither Hamid nor his staff performed the procedures as billed. Rather, Hamid and his staff allegedly taped neurostimulator devices behind patients’ ears and inserted a wire a few millimeters into patients’ ears. The device placements took place at a clinic, not a hospital or surgical center, and no incision was made on any patient.

The DOJ’s press release can be found here.