Context:

A massive fraud scheme involving at least 119 Amtrak employees and doctors resulted in the company being defrauded of $12 million over a period from 2019 to 2022. This scheme involved employees accepting cash kickbacks in exchange for allowing healthcare providers to use their and their dependents' insurance information to file fraudulent claims for services never rendered. Despite the investigation by Amtrak's Office of Inspector General, which led to the resignation or retirement of some employees, over half of those implicated remain employed. Amtrak has responded by enhancing fraud prevention measures and collaborating with medical benefit providers to curb such activities. The investigation has resulted in guilty pleas from involved healthcare providers, with significant restitution orders and ongoing legal proceedings against others involved in the scheme.

Dive Deeper:

• The fraud scheme involved Amtrak employees from the Northeast region, including Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut, and Washington, D.C., who participated in exchange for cash kickbacks from three healthcare providers.

• Healthcare providers used the employees' insurance information to submit false claims, resulting in Amtrak's health plan being billed over $16 million, with $12 million confirmed as fraudulently obtained.

• As a result of the investigation, 28 employees retired or resigned, 30 left the company for other reasons, and a dozen were criminally charged, with seven awaiting sentencing. However, 61 employees implicated in the scheme remain employed.

• Amtrak has implemented measures such as increasing oversight and encouraging employees to report suspected wrongdoing in an effort to prevent future fraud.

• An undercover investigation revealed that Punson Figueroa, an acupuncturist, was a key figure in the scheme, instructing an agent to falsify services and later submitting numerous fraudulent claims. Figueroa pleaded guilty and was sentenced to supervised release and restitution.

• Other individuals, including a podiatrist and a medical biller, also pleaded guilty to charges related to the scheme, with some awaiting sentencing.

• Amtrak has called for medical benefit providers and insurers to take more proactive measures in identifying and preventing medical insurance fraud, and continues to work with the Office of Inspector General to address these issues.