Guilty Plea Obtained in $359M Respiratory Test Fraud Case

A California woman has pleaded guilty to fraudulently submitting claims to U.S. government and private insurance programs during the COVID-19 pandemic for expensive and medically unnecessary respiratory pathogen panel (RPP) tests.
 
“Those who stole from government health programs during the COVID-19 pandemic not only violated federal law, they betrayed the public trust,” Attorney General Merrick B. Garland said. “As this action to disrupt a $359 million scheme, and the Department’s recent announcement involving over 300 defendants and over $830 million in alleged COVID-19 fraud make clear, the Justice Department will continue to find and hold accountable those who defrauded American taxpayers during the pandemic.”
 
Court documents show that 64-year-old Lourdes Navarro of Glendale, Calif., conspired with Imran Shams from June 2020 to April 2022 to obtain nasal swab specimens from residents and staff in nursing homes, assisted living facilities, rehabilitation facilities, and primary and secondary school students and staff under the guise of conducting screening tests to identify and isolate COVID-19-infected individuals. Obtaining those samples enabled Matias Clinical Laboratory—dba Health Care Providers Laboratory (HCPL)—to perform RPP tests on some of the specimens, even though only COVID-19 testing had been ordered and there was no medical justification for conducting RPP tests. Through HCPL, Navarro and Shams submitted approximately $359 million in claims for the unnecessary RPP tests to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company, and were reimbursed approximately $54 million.

“This plea marks an end to this costly healthcare fraud scheme in which bad actors fraudulently ordered medically unnecessary tests to reap ill-gotten gains,” FBI Director Christopher Wray stated. “Through coordination and close collaboration with our partners, the public can rest assured that the FBI will work relentlessly to protect our healthcare system and hold those accountable who attempt to illegally exploit it.”

Navarro pleaded guilty to conspiracy to commit healthcare fraud and wire fraud. She faces a maximum 20-year prison term when she is sentenced on Jan. 23, 2024. Shams previously pleaded guilty to conspiracy to commit healthcare fraud and is scheduled to be sentenced on Jan. 9, 2024.
 
“The defendant used her management position at a clinical testing laboratory to exploit the COVID-19 pandemic for personal gain,” Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division said. “This case demonstrates the Criminal Division’s continued resolve in working with our partners to root out bad actors who steal from government health programs.”   
 
“I would like to thank our law enforcement partners, as well as my dedicated team of investigators, analysts, and attorneys, for bringing this fraud scheme to light and shutting it down,” Inspector General Christi A. Grimm of the Department of Health and Human Services (HHS) stated. “Stealing public money is unacceptable in any circumstance, but particularly egregious when taking advantage of a public health emergency.”
 
The FBI and HHS-OIG are investigating the case.
 
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 for the Central District of California obtained seizure warrants and is handling forfeiture.
 
The Fraud Section leads the Criminal Division’s efforts to combat healthcare fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed the Medicare program for more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in healthcare fraud schemes.