Rodolfo Rivera, Health Care Fraud, New Jersey 2022

Amtrak Employee Admits to $11M Health Care Fraud Scheme

Newark, New Jersey - Rodolfo Rivera, a 41-year-old Amtrak employee from Clayton, Delaware, pleaded guilty to participating in a health care fraud scheme that defrauded Amtrak of over $11 million.

According to documents filed in the case, Rivera and his co-conspirators, who were also Amtrak employees, engaged in a scheme to obtain cash kickbacks from health care providers in return for their agreement to allow their health insurance plan to be billed for services that were never provided and were not medically necessary.

As a result of the fraudulent claims submitted on behalf of Rivera, his dependent, and other Amtrak employees that he recruited into the scheme, the Amtrak health care plan paid over $2 million in reimbursements. In total, as a result of the conspiracy, the Amtrak health care plan paid over $11 million in fraudulent claims associated with providers connected to the scheme.

Rivera received thousands of dollars in cash kickbacks from health care providers in return for his participation in the scheme, including from Punson Figueroa, an acupuncturist, and Michael DeNicola, a podiatrist. Figueroa previously pleaded guilty to conspiracy to commit health care fraud and was sentenced on September 24, 2024, to 34 months in prison. DeNicola previously pleaded guilty on June 29, 2022, to conspiracy to commit health care fraud, among other offenses. His sentencing remains pending.

The health care fraud conspiracy charge carries a maximum potential penalty of 10 years in prison and a $250,000 fine. Rivera's sentencing is scheduled for June 26, 2025.

Acting U.S. Attorney Vikas Khanna credited special agents of the Amtrak Office of Inspector General, the Amtrak Police Department, and special agents of the Drug Enforcement Administration with the investigation leading to today's guilty plea.

Defense counsel for Rivera is Dennis S. Cleary, Esq.

Source: https://www.justice.gov/usao-nj/pr/amtrak-employee-admits-participating-11-million-health-care-fraud-scheme