At least 119 Amtrak employees and doctors took the railroad company for a ride in a massive $12 million health fraud scheme, a watchdog found.
Amtrak’s Office of Inspector General (OIG) revealed that employees located in Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut, and Washington, D.C., were involved in a scheme between 2019 and 2022. They accepted cash kickbacks from three healthcare providers in exchange for using their insurance information and that of their dependents.
According to Amtrak Inspector General Kevin H. Winters, the significant number of employees participating in this fraudulent scheme indicates a severe lack of ethical standards and a concerning organizational culture in the Northeast region. The normalization of such criminal activities is alarming.
Fox News Digital has reached out to Amtrak.
An Amtrak train at Penn Station in New York City. (Getty Images)
Amtrak emphasized the need for medical benefit providers and insurers to enhance efforts in detecting suspicious behavior and preventing medical insurance fraud. The company strongly denounced the unacceptable behavior that transpired over the three-year period and is swiftly addressing the involvement of all current employees implicated in the investigation.
“While we continue to work closely with the OIG to identify and stamp out fraud, we also continue to work on other initiatives to address this issue,” the statement added. “Amtrak has implemented various measures to enhance fraud prevention and empower employees to report suspected wrongdoing. These efforts include increasing oversight and strengthening efforts to eliminate fraudulent schemes.”
Canceled trains are displayed on an Amtrak departures board in Moynihan Train Hall at Penn Station in New York Dec. 23, 2024. (Yuki Iwamura/Bloomberg via Getty Images)
The OIG launched a probe when an agent noticed unusual billing patterns in reports by data analysts. Three New York healthcare providers with “questionable” billings who shared a high number of Amtrak employees as patients were identified by investigators.
An undercover agent posing as an Amtrak employee met with Punson Figueroa, aka “Susie,” an acupuncturist from Long Island City, New York, June 16, 2021. During the visit, Figueroa told the agent to sign his name 30 times for service without dating the signatures, the OIG said.
Figueroa then submitted alleged fraudulent claims to Amtrak’s healthcare plan, saying the agent had visited providers at least seven times in May 2021 for acupuncture and physical therapy. The agent visited Figueroa’s office again on July 29, 2021, where she allegedly handed him an envelope containing $1,000.
Figueroa continued to use the agent’s insurance information to submit dozens of fraudulent claims to Amtrak’s healthcare plan, investigators said.
Figueroa pleaded guilty to defrauding Amtrak’s healthcare plan, was sentenced to three years of supervised release and was ordered to pay restitution of $9.05 million. Two other healthcare providers and a medical biller have also pleaded guilty for their roles in the scheme.
Authorities in North Tonawanda said a Niagara-bound Amtrak train struck a passenger vehicle May 17, 2024. (WKBW Buffalo)
Michael DeNicola, a podiatrist from New York, pleaded guilty June 29, 2022, to conspiracy to commit health care fraud, distribution of a controlled substance and unlawful possession of a gun. He has not yet been sentenced.
Regina Choi, a medical biller from Woodside, New York, who previously worked for Figueroa, pleaded guilty to conspiracy to commit health care fraud June 11, 2024, for submitting false and fraudulent claims to the Amtrak health care plan and paying cash kickbacks to Amtrak employees. Her sentence is also pending.
In 2018 and 2019, OIG auditors issued separate reports that said Amtrak could strengthen measures to identify fraudulent medical claims sooner. Both reports noted billing patterns indicative of potential fraud among hundreds of providers, the OIG said.
