A lab owner has been accused of fraudulently billing Medicare and insurers for more than $358 million worth of COVID-related tests that nursing home clients said they neither wanted nor needed.
The Justice Department on Thursday announced the indictment of Lourdes Navarro, 64, of Glendale, CA, as part of a coordinated COVID-19 fraud initiative. Law enforcement officials said Navarro, the manager and operator of Matias Clinical Laboratory, delivered actual COVID screening for nursing homes, rehab facilities and schools.
But to enrich herself and the lab (which is also known as Health Care Providers Laboratory), she also charged for respiratory pathogen panels that were not ordered nor medically unnecessary. Some of those tests were procured through illegal kickbacks and bribes, and were ineligible for reimbursement, the Justice Department said.
The nursing homes involved either told the lab they didn’t need or want the tests, and the government did not allege any wrongdoing on their part.
“Matias fraudulently added claims for RPP tests even though medical providers and facility administrators did not order them, and such tests were not needed for the patient population Matias served,” explained a case summary prepared by federal law enforcement.
Victims included Medicare, a Health Resources and Services Administration program for the uninsured, and a private insurance company.
Navarro was previously charged in an indictment last April. Thursday’s announcement outlined additional, new charges and said Navarro conspired with her husband, Imran Shams, in the scheme. Those charges alone resulted in $241 million in billed claims, with an extra $39.9 million paid to the lab.
“It is particularly offensive to discover individuals who took advantage of the pandemic to defraud the government,” CMS Administrator Chiquita Brooks-LaSure said in a statement announcing a total of $490 billion in false COVID-related billings.
Thursday’s announcement highlighted charges against 18 defendants in nine federal districts for their alleged roles in various fraud schemes involving healthcare services that “exploited the COVID-19 pandemic.” Several individuals were charged with claiming funds through the Provider Relief, Paycheck Protection, and Economic Injury Disaster Loan programs and using proceeds on luxury personal items.
Among those targeted were four individuals charged with manufacturing or distributing forged vaccination cards, including two men who sold about 120,000 counterfeit vaccination cards online between March 2021 and September 2021 and two midwives who conspired to forge vaccination records at their New York clinic. The Justice Department noted that their small private practice was one of the busiest “vaccination” sites in the state, “outpacing large, state-run vaccination sites.”
