NEWARK, NJ — Three men and one woman were arrested June 23 for their alleged participation in a health care fraud scheme to defraud Amtrak by bribing Amtrak employees to allow people to submit fraudulent claims to the Amtrak health insurance plan, U.S. Attorney Philip R. Sellinger announced.
Muhammad Mirza, 50, of Cedar Grove; Devon Burt, 49, of Blue Bell, Pa.; and Hallum Gelzer, 43, of East Orange, were charged by complaint in Newark federal court with conspiracy to commit health care fraud. Punson Figueroa, aka “Susie Figueroa,” 55, of Long Island City, N.Y., was charged in the same complaint with 15 counts of health care fraud. The defendants appeared by videoconference June 23 before U.S. Magistrate Judge James B. Clark III and were released on $200,000 unsecured bond.
According to documents filed in this case and statements made in court, from 2019 to the present, Mirza, Figueroa, Gelzer, Burt and others recruited Amtrak employees — primarily from New Jersey and New York — to participate in the scheme through the offer of cash payments, in exchange for the employees agreeing to allow Mirza, Figueroa and others to use their patient and insurance information to submit fraudulent claims. Mirza, Figueroa and others allegedly benefited from this scheme by receiving payments from the Amtrak health care plan for services that were never provided or that were medically unnecessary. Gelzer, Burt and others reportedly benefited from this scheme by receiving cash payments from providers in return for allowing those providers to use their personal and insurance information to submit fraudulent claims and in return for recruiting others to participate in the scheme.
On June 17, 2021, an undercover law enforcement agent posing as an Amtrak employee met with Figueroa at Figueroa’s office in New York. Figueroa reportedly instructed the undercover agent to sign his name about 30 times for services received and instructed the undercover agent not to date the signatures. According to law enforcement, Figueroa told the undercover agent that the undercover agent had good insurance, and that Amtrak has very good benefits; Figueroa submitted or caused to be submitted false claims to Amtrak’s health care plan indicating that the undercover agent had visited providers at least seven times in May 2021, purportedly receiving acupuncture and physical therapy services.
The undercover agent visited Figueroa’s office on one other occasion, on July 29, 2021. At this meeting, which was recorded on audio and video, Figueroa handed the undercover agent an envelope filled with $1,000. Figueroa continued to use the undercover agent’s personal and insurance information to submit fraudulent claims to the Amtrak health care plan, for a total of 73 claims. As a result of these fraudulent claims, the Amtrak health care plan paid $31,840.
In total, the Amtrak health care plan has paid at least approximately $9 million as a result of claims associated with providers connected to the health care fraud scheme.
The conspiracy and health care fraud charges each carry a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest.
The charges and allegations contained in the complaint are merely accusations, and the defendants are presumed innocent unless and until proved guilty.
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