Federal Reports

Nestor Rojas, a resident of Miami, pleaded guilty in U.S. District Court, Middle District of Florida, to one count of conspiracy to commit health care fraud and wire fraud on April 21, 2022. Our investigation found that Rojas conspired with others to unlawfully bill for approximately $1.4 billion of laboratory testing services which were medically unnecessary and fraudulently used rural hospitals as billing shells to submit claims for services that mostly were performed at outside laboratories. As a result of this scheme, Amtrak’s health care plans paid out more than $610,000 to three rural hospitals and associated laboratories. Rojas will be sentenced at a future date. Criminal judicial proceedings for additional co-conspirators are pending.

Dominique Henley, a former Amtrak baggageman based in Chicago, pleaded guilty to identity theft and was sentenced in the Circuit Court of Cook County, Illinois, on April 20, 2022, to 24 months’ probation. Our investigation found that Henley was in possession of 21 Social Security cards and 13 state and government-issued identification cards belonging to 21 different individuals. We found that of the 21 individuals’ identification documents in his possession, 19 were previously located in the Chicago Union Station lost and found or were reported lost on Amtrak trains. Henley was terminated from employment on November 3, 2020.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Syracuse VA Medical Center and multiple outpatient clinics in New York. The inspection covered key clinical and administrative processes that are associated with promoting quality care. It focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Medication Management: Remdesivir Use in VHA; Mental Health: Emergency Department and Urgent Care Center Suicide Risk Screening and Evaluation; Care Coordination: Inter-facility Transfers; and High-Risk Processes: Management of Disruptive and Violent Behavior.At the time of the inspection, the medical center’s executive leadership team appeared stable, with all positions permanently assigned. Leaders had worked together almost five months, although some had served in their positions for more than five years. Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress. Patients generally appeared satisfied with the care provided. The OIG’s review of the accreditation findings did not identify any organizational risk factors. However, the OIG noted concerns related to patient safety and risk management. Executive leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to take actions to sustain and improve performance.The OIG issued seven recommendations for improvement in three areas:(1) Leadership and Organizational Risks• Sentinel events and institutional disclosures(2) Quality, Safety, and Value• Systems redesign and improvement coordinator meeting participation• Surgical work group administration and data analysis(3) High-Risk Processes• Disruptive behavior committee meeting attendance• Staff training