A Georgia man was arrested for allegedly orchestrating a scheme to defraud healthcare benefit programs, including Tricare, over COVID-19 and genetic cancer testing, the Justice Department announced Monday.
Erik Santos, 49, of Braselton, Ga., was set to appear in court Monday, charged by complaint with one count of conspiring to violate the anti-kickback statute and one count of conspiring to commit healthcare fraud, according to U.S. Attorney Craig Carpenito.
Santos was arrested at his home Monday by FBI special agents. He's accused of running a marketing company that generated leads for testing companies.
From November 2019 until now, Santos and others allegedly operated "a large-scale scheme to defraud Medicare by soliciting and receiving kickback payments from companies involved in clinical and diagnostic testing in exchange for steering to those companies individuals eligible for testing that Medicare would reimburse," according to the DoJ.
Santos allegedly had agreements to be paid kickbacks on a "per-test basis" for submitting tests to diagnostic facilities "regardless of medical necessity." His scheme allegedly led to more than $1.1 million in fraudulent Medicare claims.
Beginning in February, however, Santos allegedly used the pandemic as an opportunity to expand his scheme to COVID-19 tests, getting kickbacks for virus tests that were bundled with "more expensive respiratory pathogen panel tests" which do not identify or treat COVID-19.
On March 19, Santos allegedly said on a phone call that he believed the COVID-19 pandemic was a chance to cash in.
"While there are people going through what they are going through, you can either go bankrupt or you can prosper," Santos said on the call, according to DoJ. "The good thing is we’re opening a lot of doors through this coronavirus testing."
He also allegedly said he put his other work on hold because "everybody has been chasing the COVID dollar bird."
“The complaint in this case describes a defendant who saw the spread of COVID-19 as nothing more than an opportunity to profit personally,” Carpenito said in a statement. “As the complaint alleges, he offered kickbacks in exchange for medically unnecessary tests – including potentially hard-to-obtain COVID-19 tests – thus preying on people’s fear in order to defraud the government and make money for himself. The U.S. Attorney’s Office and our law enforcement partners are focused on protecting the public from this kind of despicable pandemic profiteering, and will act quickly to halt the fraud and bring the perpetrators to justice.”
“It is unfortunate that we have people in our country who will capitalize on others' suffering to make a buck,” Special Agent-in-Charge Gregory W. Ehrie of FBI Newark said. “But this case takes things to a new low. This defendant not only allegedly defrauded the government, he conspired to bilk his fellow citizens of a valuable resource that's in high demand. His profiteering is akin to receiving blood money. Throughout this challenging crisis, the FBI remains on duty and vigilant in our efforts to capture anyone who puts money before humanity."
Santos' scheme allegedly targeted healthcare benefits programs including Medicare and Tricare.
Defense Criminal Investigative Service (DCIS) Northeast field office Special Agent-in-Charge Leigh-Alistair Barzey said the agency was committed to working with DoJ and law enforcement "to combat health care fraud and protect Tricare, the DoD's healthcare system, and the military members and their families who depend upon it.”
Santos faces a potential 15 total years in prison and fines of up to $250,000.