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Man charged with billing for fraudulent test claims

Items from a COVID-19 test kit are displayed for a photograph.

Michael Nagle | Bloomberg | Getty Images

Federal prosecutors have criminally charged a Georgia man for allegedly conspiring to defraud federal and private health-care benefit programs “by submitting fraudulent testing claims” for coronavirus and genetic cancer screenings, authorities announced Monday.

The man, 49-year-old Erik Santos is accused in a complaint by the U.S. Attorney’s Office for the District of New Jersey of one count of conspiring to violate the Anti-Kickback Statute, and a single count of conspiring to commit health care fraud. He faces up to 15 years in prison if convicted of both counts.

Prosecutors said that during a phone call on March 19, Santos explained how he viewed the coronavirus outbreak as a chance to make money.

“[W]hile there are people going through what they are going through, you can either go bankrupt or you can prosper,” Santos said on that call, according to prosecutors.

During the same call, prosecutors said, “Santos noted that his other work was on hold because ‘everybody has been chasing the Covid dollar bird.'”

Santos was arrested at his home in Braselton, Georgia, on Monday by FBI agents, and is scheduled to appear in Atlanta federal court later in the day, according to authorities.

Santos’ alleged “scheme aimed to submit more than $1.1 million in fraudulent claims to Medicare,” according to a statement from the U.S. attorney’s office in New Jersey.

U.S. Attorney Craig Carpenito in a statement said, “The complaint in this case describes a defendant who saw the spread of COVID-19 as nothing more than an opportunity to profit personally.”

“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,” Carpenito said.

Special Agent in Charge Gregory Ehrie of the FBI’s Newark office said, “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,” Ehrie said.

According to Carpenito’s office, “Santos ran a marketing company that generated leads to testing companies.”

“From November 2019 through the present, Santos and others engaged in 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,” the office said.

Prosecutors claim that Santos “agreed with others to be paid kickbacks on a per-test basis for submitting genetic cancer screening tests to diagnostic testing facilities, regardless of medical necessity.” A genetic cancer screening is a diagnostic tool that tests for a genetic predisposition to cancer. Santos’ scheme aimed to submit more than $1.1 million in fraudulent claims to Medicare.

Prosecutors also said that as the coronavirus pandemic grew, Santos used it as an opportunity “to expand his pre-existing kickback schemes and to capitalize on a national emergency for his own financial gain.”

“Santos agreed with others to be paid kickbacks on a per-test basis for COVID-19 tests, provided that those tests were bundled with a much more expensive respiratory pathogen panel (RPP) test, which does not identify or treat COVID-19,” the New Jersey U.S. attorney’s office said in a statement.

“Santos sought to maximize his kickback profits and to bleed federal health care resources at a time when Medicare beneficiaries across the United States were in dire need of coverage for medical treatment and services.”

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