Woman pleads guilty to $359 million fraud involving claims for unnecessary respiratory tests submitted with COVID-19 tests

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A California woman pleaded guilty to fraudulently submitting claims to governmental and private insurance programs during the COVID-19 pandemic for expensive and medically unnecessary respiratory pathogen panel (RPP) tests.

According to court documents, from June 2020 to April 2022, Lourdes Navarro, 64, of Glendale, conspired with Imran Shams to obtain nasal swab specimens from residents and staff at nursing homes, assisted living facilities, rehabilitation facilities, and 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. Obtaining those samples enabled Matias Clinical Laboratory, dba Health Care Providers Laboratory (HCPL), to perform RPP tests on some of the specimens, even though only COVID-19 testing had been ordered and even though there was no medical justification for conducting RPP tests. Navarro and Shams submitted, through HCPL, approximately $359 million in claims for the unnecessary RPP tests to Medicare, the Health Resources and Services Administration COVID-19 Uninsured Program, and a private health insurance company, and were reimbursed approximately $54 million.

Navarro pleaded guilty to conspiracy to commit health care fraud and wire fraud. She is scheduled to be sentenced on Jan. 23, 2024, and faces a maximum penalty of 20 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Shams previously pleaded guilty to conspiracy to commit health care fraud and is scheduled to be sentenced on Jan. 9, 2024.

The FBI and HHS-OIG are investigating the case.

Trial Attorneys Gary A. Winters and Raymond E. Beckering III of the Criminal Division’s Fraud Section are prosecuting the case. Assistant U.S. Attorney Maxwell Coll for the Central District of California obtained seizure warrants and is handling forfeiture.