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East Orange Man Among Four Busted by the Feds for Health Care Fraud

By rlsmetro on
New Jersey

Three men and one woman were arrested today for participating 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.

According to federal officials, Muhammad Mirza, 50, of Cedar Grove, New Jersey; Devon Burt, 49, of Blue Bell, Pennsylvania; and Hallum Gelzer, 43, of East Orange, New Jersey, were charged by complaint with conspiracy to commit health care fraud in Newark federal court. Punson Figueroa, aka “Susie Figueroa,” 55, of Long Island City, New York, was charged in the same complaint with 15 counts of health care fraud.

The defendants appeared by videoconference today before U.S. Magistrate Judge James B. Clark III and were released on a $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 benefitted 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 benefitted 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 instructed the undercover agent to sign his name about 30 times for services received and instructed the undercover agent not to date the signatures.

Figueroa stated to 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 only 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.