WEST PALM BEACH, Fla. — Jose Goyos, 38, of West Palm Beach, was sentenced on Friday to 15 years in prison for his role in a large-scale scheme that defrauded Medicare of $67 million. Goyos worked at a call center that engaged in fraudulent activities involving medically unnecessary genetic testing.
According to the Department of Justice (DOJ), Goyos managed the call center’s “doctor chase” division, which targeted primary care physicians who treated Medicare beneficiaries. The fraudulent operation tricked doctors into ordering genetic tests that had no medical purpose.
The call center employees created fake medical paperwork and falsely claimed the Medicare beneficiaries were “mutual patients” who requested genetic testing. Additionally, they falsely claimed that the patients had conditions that justified the testing. Once they obtained orders from the physicians, Goyos and his co-conspirators submitted fraudulent claims to Medicare for payment.
The genetic tests were expensive, and the results were rarely shared with the physicians. The scheme operated from May 2020 to July 2021, generating more than $67 million in Medicare bills, of which $53 million was paid by Medicare.
In October 2023, a federal jury found Goyos guilty of conspiring to commit wire fraud and money laundering. Nine other co-defendants involved in the fraudulent operation were also convicted and sentenced to prison terms ranging from two years to more than 16 years.
This case serves as a significant example of Medicare fraud, with the DOJ emphasizing the need for stricter oversight and accountability in the health care industry.
