SoCal woman guilty of $359 million fraud scheme targeting federal healthcare program

A Glendale woman was convicted of a $359 million fraud scheme targeting federal healthcare programs.

The woman was identified as Lourdes Navarro, 64, by the U.S. Attorney’s Office.

Navarro pleaded guilty to collecting millions by fraudulently submitting claims to government and private insurance programs during the COVID-19 pandemic. Specifically, her claims involved “expensive and medically unnecessary respiratory pathogen panel (RPP) tests,” officials said.

From June 2020 to April 2022, Navarro and an accomplice, Imran Shams, conducted screening tests to identify patients infected with COVID-19. They obtained nasal swab samples from staff and residents at a variety of places including nursing homes, assisted living facilities, rehabilitation facilities, and students and staff at local schools.

With those collected samples, Matias Clinical Laboratory, dba Health Care Providers Laboratory, performed RPP tests on the samples, despite only being ordered to test for COVID-19. 

Navarro submitted around $359 million in claims for those tests to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company. They were reimbursed approximately $54 million.

”There was no medical justification for conducting RPP tests,” court documents said.

“The defendant used her management position at a clinical testing laboratory to exploit the COVID-19 pandemic for personal gain,” said Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division.

Navarro pleaded guilty to conspiracy to commit health care fraud and wire fraud. She faces up to 20 years in prison. A sentencing hearing is scheduled for Jan. 23, 2024. 

Navarro’s accomplice, Shams, pleaded guilty to conspiracy to commit healthcare fraud and is scheduled to be sentenced on Jan. 9, 2024.

“Those who stole from government health programs during the COVID-19 pandemic not only violated federal law, they betrayed the public trust,” said Attorney General Merrick B. Garland. “As this action to disrupt a $359 million scheme, and the Department’s recent announcement involving over 300 defendants and over $830 million in alleged COVID-19 fraud make clear, the Justice Department will continue to find and hold accountable those who defrauded American taxpayers during the pandemic.”

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