A California woman has been sentenced to nine years in prison for her role in fraudulently submitting claims to governmental and private insurance programs during the COVID‑19 pandemic for expensive respiratory pathogen panel tests that were medically unnecessary and never ordered by healthcare providers.
According to court documents, Lourdes Navarro, 66, of Glendale, and Imran Shams owned and controlled Matias Clinical Laboratory, doing business as Health Care Providers Laboratory.
Navarro and Shams conspired to obtain nasal swab specimens that enabled HCPL to test for COVID-19, as well as to obtain testing orders from physicians and other medical professionals.
The specimens were collected from, among others, residents and staff at nursing homes, assisted living facilities, rehabilitation facilities, and similar types of facilities, and from students and staff at primary and secondary schools, for the purported purpose of conducting screening tests to identify and isolate individuals infected with COVID-19.
However, Navarro and Shams caused HCPL to perform RPP tests on most of the specimens, even though only COVID-19 testing had been ordered and there was no medical justification for conducting RPP tests on asymptomatic individuals who needed only COVID-19 screening tests.
Through HCPL, Navarro and Shams billed approximately $369 million for the RPP tests to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company and were reimbursed approximately $46.7 million for fraudulent claims.
Navarro was also ordered to forfeit $11,662,939 in funds that the government had previously seized from three bank accounts. The total amount seized and forfeited from Navarro and Shams is $14,518,485. Navarro also was ordered to pay $46,735,400 in restitution.
Navarro pleaded guilty on October 5, 2023, to conspiracy to commit health care fraud and wire fraud. Shams pleaded guilty on January 24, 2023, in the Central District of California to conspiracy to commit health care fraud and concealment of his exclusion from Medicare and was sentenced to 10 years in prison on January 30, 2024.
In addition, on May 29, 2024, Shams was sentenced to five years in prison in connection with his 2017 plea in the Eastern District of New York to conspiracy to commit money laundering, conspiracy to pay and receive kickbacks, and defrauding the United States by obstructing the lawful functions of the IRS, of which three years were ordered to run consecutive to the Central District of California sentence.
