Amtrak employees bilked the company for millions in medical insurance fraud, officials say

In a shocking revelation, it has been uncovered that at least 119 Amtrak employees and doctors were involved in a massive $12 million health fraud scheme. The Amtrak Office of Inspector General (OIG) discovered that employees from various states including Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut, and Washington, D.C., accepted cash kickbacks from healthcare providers in exchange for the use of their insurance information and that of their dependents from 2019 to 2022.
This unethical behavior involved the healthcare providers filing fraudulent and unnecessary medical claims using the employee’s information, resulting in a total of $16 million billed to Amtrak’s health plan, with $12 million being fraudulently obtained. The OIG’s investigation revealed a troubling workforce culture in the Northeast region where criminal behavior was normalized.
Out of the 119 employees implicated, 28 retired or resigned, 30 left for other reasons, 12 have been criminally charged, and seven have pleaded guilty and are awaiting sentencing. Sixty-one employees are still employed by Amtrak. The company has taken significant steps to address medical insurance fraud and is working closely with the OIG to eliminate fraudulent schemes.
Amtrak has implemented various measures to prevent fraud and empower employees to report suspicious activities. The OIG initiated the probe after noticing unusual billing patterns and identified three healthcare providers in New York with questionable billings. An undercover agent posing as an Amtrak employee uncovered the fraudulent activities, resulting in guilty pleas from the healthcare providers involved.
One of the providers, Punson Figueroa, pleaded guilty to defrauding Amtrak’s healthcare plan and was sentenced to supervised release and restitution. Additionally, a podiatrist and a medical biller have also pleaded guilty for their roles in the scheme. Previous reports from OIG auditors had highlighted the need for Amtrak to strengthen measures to identify fraudulent medical claims promptly.
Moving forward, Amtrak is committed to enhancing fraud prevention efforts and ensuring the integrity of its healthcare plan. The company condemns the reprehensible acts that occurred and is taking swift action to address the issue. By working closely with the OIG and implementing rigorous oversight, Amtrak aims to eliminate fraudulent schemes and uphold ethical standards within the organization.