On January 28, the government announced that California resident Lourdes Navarro, 66, was sentenced to nine years in prison for her involvement in submitting fraudulent claims to both government and private insurance companies during the COVID-19 pandemic. Navarro and her co-conspirator, Imran Shams, illegally bundled COVID-19 screening tests with expensive and medically unnecessary respiratory pathogen panel (RPP) tests that providers never ordered.

Navarro and Shams owned and operated Matias Clinical Laboratory, doing business as Health Care Providers Laboratory (HCPL). Shams and Navarro conspired to acquire nasal swab specimens that allowed HCPL to test for COVID-19. They gathered specimens from an assortment of individuals including residents and staff at nursing homes, rehabilitation facilities, students and staff and schools, and others to conduct screening tests to isolate individuals with COVID-19.

Navarro and Shams had HCPL perform RPP tests on most specimens even though physicians and other medical professionals ordered only COVID-19 screening and there was no medical need for RPP tests on asymptomatic people.

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 ordered to forfeit $11,662,939 in funds that the government previously seized from three bank accounts. The total sum seized and forfeited from Navarro and Shams is $14,518,485. Navarro will also pay $46,735,400 in restitution.

On October 5, 2023, Navaro pleaded guilty to conspiracy to commit health care fraud and wire fraud. On January 23, 2023, Shams pleaded guilty to conspiracy to commit health care fraud and concealment of his exclusion from Medicare and was sentenced on January 30, 2024 to 10 years in prison. Shams is also serving a separate five-year prison sentence for a case involving conspiracy to commit money laundering, conspiracy to pay and receive kickbacks, and defrauding the United States by obstructing the lawful functions of the IRS. Three of those five years will run consecutively with his ten-year sentence.

Alysia Solow, partner of Constantine Cannon, commented: “Healthcare fraud undermines the trust and integrity of a system meant to heal and protect. Reporting it is not just a responsibility – it’s a vital step in safeguarding the wellbeing of individuals and ensuring that resources are used where they are needed most.”

If you have any information relating to healthcare fraud, would like to learn more about what it means to be a whistleblower, or want to speak to an experienced member of the Constantine Cannon whistleblower lawyer team, please contact us for a free and confidential consultation.

Read California Woman Sentenced in $369M Fraud Scheme Involving Billing for Medically Unnecessary Respiratory Tests at constantinecannon.com