New York Acupuncturist Admits $9 Million Health Care Fraud Targeting Amtrak

NEWARK, N.J. – A New York acupuncturist today admitted participating in a $9 million health care fraud scheme to defraud Amtrak, U.S. Attorney Philip R. Sellinger announced.

Punson Figueroa, aka “Susie,” 57, of Long Island City, New York, pleaded guilty before U.S. District Judge Madeline Cox Arleo in Newark federal court to an information charging her with conspiracy to commit health care fraud.

“This defendant has admitted to fleecing the health care system for millions of dollars in illicit claims,” U.S. Attorney Sellinger said. “Submitting fraudulent claims to steal money harms the public and the health care system. My office and our partners are committed to stopping health care scams and ensure that guilty participants are punished.”

“We remain fully committed to bringing justice to those who target Amtrak’s health care plans, including Amtrak employees who wrongly accept payments for the use of their insurance information to further such schemes,” said Amtrak’s Inspector General, Kevin H. Winters. “We hope this case serves as a deterrent for health care providers and Amtrak employees who may choose to engage in such schemes, and we ask anyone who suspects or observes such fraud to report it to our fraud, waste, and abuse hotline.”

“This investigation unveiled the mastermind behind a $9 million health care fraud scheme,” DEA – New York Special Agent in Charge Frank Tarentino said. “I applaud our law enforcement partners whose diligent work put an end to this conspiracy and brought Punson Figueroa to justice to face the consequences of her illegal actions.” 

“This case demonstrates Amtrak’s resolve to work alongside all our law enforcement partners to investigate and hold accountable those who attempt to defraud the system,” Chief Sam Dotson said. “We are grateful for the collaborative law enforcement effort that led to this guilty plea, and we will continue to be vigilant in safeguarding Amtrak’s assets.”

According to documents filed in this case and statements made in court:

From January 2019 through June 2022, Figueroa and her conspirators agreed to engage in a scheme to bill the Amtrak health care plan for fraudulent claims for services that never were provided and were medically unnecessary. Figueroa recruited Amtrak employees to participate in the scheme by paying them cash in return for allowing her to use their personal and insurance information to submit false and fraudulent claims. Figueroa conspired with dozens of Amtrak employees and paid hundreds of thousands of dollars in cash kickbacks to Amtrak employees over the course of the scheme. 

On June 16, 2021, an undercover law enforcement agent posing as an Amtrak employee met with Figueroa at Figueroa’s office in New York. Figueroa instructed the undercover agent to sign his name about 30 times for services received and instructed the undercover agent not to date the signatures. Figueroa caused false claims to be submitted to Amtrak’s health care plan indicating that the undercover agent had visited providers at least seven times in May 2021, purportedly receiving acupuncture and physical therapy services.

The undercover agent visited Figueroa’s office on only one other occasion, on July 29, 2021. At this meeting, Figueroa handed the undercover agent an envelope filled with $1,000. Thereafter, Figueroa continued to use the undercover agent’s personal and insurance information to submit dozens of fraudulent claims to the Amtrak health care plan.

In total, Figueroa caused Amtrak to pay out over $9 million in false and fraudulent insurance claims.

The charge of conspiracy to commit health care fraud carries a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest. Sentencing is scheduled for July 16, 2024.

U.S. Attorney Sellinger credited special agents of the Amtrak Office of Inspector General, under the direction of Special Agent in Charge Michael J. Waters, special agents of the Drug Enforcement Administration, under the direction of Special Agent in Charge Frank A. Tarentino III in New York, and the Amtrak Police Department, under the direction of Chief of Police Sam Dotson, with the investigation leading to today’s guilty plea.

The government is represented by Assistant U.S. Attorneys Katherine M. Romano and Jessica R. Ecker of the Health Care Fraud Unit in Newark.