A watchdog report revealed that at least 119 Amtrak employees and doctors defrauded the rail service of $12 million through a health insurance scam.
According to Amtrak’s Office of Inspector General (OIG), employees located in Pennsylvania, Delaware, New Jersey, New York, Maryland, Connecticut, and Washington, D.C., received kickbacks from three healthcare providers in exchange for their insurance information, and that of their dependents, between 2019 and 2022.
Amtrak Inspector General Kevin H. Winters stated that the high number of employees participating in the scheme indicates a serious ethical lapse and a concerning work environment, particularly in the Northeast, where such criminal behavior seemed normalized.
Digital has reached out to Amtrak.
The OIG reported that healthcare providers used the employee information to submit fraudulent medical claims for services either not provided or medically unnecessary. The railroad’s health plan, funded by taxpayers, was billed over $16 million, resulting in a $12 million loss.
Of the 119 implicated employees, 28 retired or resigned due to the OIG investigation, and 30 left for “other reasons.” Twelve employees face criminal charges, and seven have pleaded guilty and are awaiting sentencing.
Sixty-one employees remain employed by Amtrak.
Amtrak told Digital in a statement that it has taken “significant steps” to combat medical insurance fraud.
The company stated that, like many employers, it relies on medical benefit providers and insurers to detect and prevent fraudulent activity. Amtrak condemned the actions that occurred between 2019 and 2022 and is taking action against all active employees involved.
The statement further noted that Amtrak is working with the OIG to eliminate fraud and has implemented measures to enhance fraud prevention and encourage employees to report suspected wrongdoing, including increased oversight and efforts to eliminate fraudulent schemes.
The OIG investigation began after an agent noticed unusual billing patterns identified by data analysts. Investigators identified three New York healthcare providers with “questionable” billings who shared many Amtrak employees as patients.
An undercover agent, posing as an Amtrak employee, met with Punson Figueroa, also known as “Susie,” an acupuncturist from Long Island City, New York, on June 16, 2021. The OIG reported that Figueroa instructed the agent to sign his name 30 times for services without dating the signatures.
Figueroa then allegedly submitted claims to Amtrak’s healthcare plan, stating the agent had at least seven visits in May 2021 for acupuncture and physical therapy. The agent revisited Figueroa’s office on July 29, 2021, where Figueroa allegedly gave him an envelope with $1,000.
Investigators stated that Figueroa continued using the agent’s insurance information to file numerous fraudulent claims with Amtrak’s healthcare plan.
Figueroa pleaded guilty to defrauding Amtrak’s healthcare plan, received three years of supervised release, and was ordered to pay $9.05 million in restitution. Two other healthcare providers and a medical biller also pleaded guilty for their roles in the scheme.
Michael DeNicola, a podiatrist from New York, pleaded guilty on June 29, 2022, to conspiracy to commit health care fraud, distribution of a controlled substance, and unlawful possession of a gun. His sentencing is pending.
Regina Choi, a medical biller from , who previously worked for Figueroa, pleaded guilty on June 11, 2024, to conspiracy to commit health care fraud for submitting false claims to the Amtrak health care plan and paying kickbacks to Amtrak employees. Her sentence is also pending.
In 2018 and 2019, OIG auditors issued reports stating that Amtrak could improve its measures to identify fraudulent medical claims earlier. The OIG noted that both reports indicated billing patterns suggestive of potential fraud among numerous providers.
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