Lourdes Navarro, a 64-year-old resident of Glendale, California, has entered a guilty plea in a fraudulent scheme that exploited federal and private insurance programs during the COVID-19 pandemic. The scheme, which totaled a staggering $359 million, involved the submission of claims for expensive and medically unnecessary respiratory pathogen panel (RPP) tests, purportedly alongside COVID-19 screening tests.
The fraudulent operation was carried out from June 2020 to April 2022, wherein Navarro, alongside Imran Shams, secured nasal swab specimens from various groups, including nursing home residents and staff, those in assisted living and rehabilitation facilities, as well as students and staff at primary and secondary schools. These samples were then used by Matias Clinical Laboratory, doing business as Health Care Providers Laboratory, to conduct RPP tests without medical justification or specific orders, despite the claims being solely for COVID-19 testing.
The fraudulent claims were submitted to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company, resulting in reimbursements of approximately $54 million. Court documents highlighted that there was no medical justification for conducting RPP tests on the samples collected under the pretext of COVID-19 testing.
The case has garnered attention from various federal officials, emphasizing the gravity of the crime. U.S. Attorney General Merrick B. Garland condemned the breach of public trust and highlighted the Justice Department's commitment to prosecuting those who have exploited the pandemic for financial gain. Similarly, FBI Director Christopher Wray and Acting Assistant Attorney General Nicole M. Argentieri have spoken on the coordination and resolve to combat healthcare fraud, particularly in times of public health emergencies.
Navarro has pleaded guilty to conspiracy to commit health care fraud and wire fraud, facing a maximum penalty of 20 years in prison, with her sentencing scheduled for January 23, 2024. Her accomplice, Shams, also pleaded guilty to conspiracy to commit health care fraud and is slated for sentencing on January 9, 2024. The case has been a focal point for the Justice Department’s efforts to fight health care fraud, particularly through the Health Care Fraud Strike Force Program, which has been instrumental in charging thousands of defendants involved in Medicare fraud amounting to billions of dollars.
The revelation of Navarro's guilt and the sheer scale of the fraud has sent shockwaves through Southern California's healthcare scene, exposing the vulnerabilities and the extent of exploitation during the pandemic. The case has been reported by several news outlets, including the U.S. Department of Justice’s official website, Newsbreak, and MyNewsLA, indicating the broad coverage and public interest in the matter1234.