Fraud investigator helps shut down COVID-19 testing fraud

Multiple health plans were getting COVID-19 testing bills from providers their systems hadn't seen before. The health plans contacted Sgt. Dana with TDI's Fraud Unit, who they worked with on other fraud cases.

"When the system throws up red flags, it means someone needs to look at it," said Dana. "The plans tried to verify the provider and make contact, but they were shell companies."

Dana started investigating and found several fake North Texas-based labs unlawfully using patient information to bill health plans more than $30 million for running COVID-19 tests.

The primary suspect stole patient information from pain clinics where he worked as a contract lab tech. Three friends helped with the scheme.

One patient said he got a letter in the mail saying his health plan was billed for 15 COVID-19 tests he supposedly took. The patient had no idea. He’d taken no tests.

Dana investigated the case with help from several federal agencies, including the FBI, U.S. Department of Labor and Employee Benefits Security Administration, and the U.S. Attorney’s Office in the Northern District of Texas.

Four people pleaded guilty to health care fraud. The lab tech got seven years in prison and was ordered to pay back $7 million.

Dana joined TDI in 2019 after retiring from the Arlington Police Department.

He said he likes his job investigating insurance fraud. "I like putting puzzles together. It’s a big puzzle trying to figure out what people are doing, how they’re doing it, and holding them accountable."

Learn more

• Insurance fraud guide
• Report fraud