Amtrak has uncovered its largest employee criminal conspiracy ever, with 119 workers involved in a $12 million health insurance fraud scheme that operated for years before authorities finally cracked down.
Quick Takes
- 119 Amtrak employees participated in a massive health care fraud scheme from 2019 to 2022, defrauding the company’s health plan of over $12 million
- Employees received cash kickbacks from health care providers for allowing fraudulent claims to be filed using their insurance information
- So far, 28 employees have retired or resigned, 30 have left for other reasons, and 12 have been criminally charged with 7 pleading guilty
- The scam involved employees in several northeastern states who signed fake treatment forms and received cash payments in return
- Amtrak is implementing new measures to prevent future fraud, including employee education and improved claims monitoring
Multi-Million Dollar Fraud Scheme Exposed
Federal investigators have uncovered what they’re calling the largest employee criminal conspiracy in Amtrak’s history, involving 119 workers who participated in a sophisticated $12 million health care fraud scheme. The scam, which operated between January 2019 and June 2022, saw employees colluding with health care providers to submit fraudulent claims for treatments that were either unnecessary or never provided. The investigation began after analysts noticed unusual billing patterns from several New York-based health care providers, leading to a wide-ranging probe that revealed the shocking scale of the fraud.
Amtrak employee Rodolfo Rivera recently pleaded guilty in Newark federal court to conspiracy to commit health care fraud, becoming one of several individuals facing serious legal consequences. According to court documents, Rivera and his co-conspirators received cash kickbacks from health care providers, including an acupuncturist and a podiatrist, in exchange for allowing fraudulent claims to be filed using their insurance information. The health care fraud conspiracy charge carries a maximum penalty of 10 years in prison and a $250,000 fine, with Rivera’s sentencing scheduled for June 26, 2025.
How the Fraud Operation Worked
The investigation revealed that the scheme involved employees from multiple northeastern states and Washington, D.C. Two key figures in the scam, Devon Burt and Hallum Gelzer, actively recruited their fellow Amtrak employees to participate in the fraud and sometimes threatened healthcare providers for larger kickbacks. Undercover operations conducted by investigators exposed how the fraud worked: employees would sign undated papers for fake treatments, then receive cash kickbacks ranging from $100 to $1,000 while the health care providers billed Amtrak’s insurance plan for services never rendered.
“The sheer volume of employees who cavalierly participated in this scheme to steal Amtrak’s funds suggests not only a serious lapse in basic ethics, but a troubling workforce culture, at least in the Northeast region, in which blatant criminal behavior was somehow normalized.” Amtrak Inspector General Kevin H. Winters
The investigation was conducted by special agents from the Amtrak Office of Inspector General, Amtrak Police Department, and the DEA. Their work has resulted in serious consequences for those involved: 28 Amtrak employees have retired or resigned, 30 have left for other reasons, and 12 have been criminally charged, with seven already pleading guilty. Additionally, the OIG has submitted its findings on 61 active employees to Amtrak management for potential disciplinary action.
Amtrak’s Response and Prevention Efforts
Amtrak has responded forcefully to the scandal, condemning the participants and implementing measures to prevent similar fraud in the future. The company is working closely with the OIG to strengthen controls and prevent abuse, including enhanced employee education about fraud, improved monitoring of claims, and enrolling employees in more cost-efficient health care plans. Previous OIG reports from 2018 and 2019 had suggested that Amtrak could improve measures to detect fraudulent claims earlier, advice that appears particularly relevant in light of this massive scheme.
“Amtrak strongly condemns this reprehensible act that occurred between 2019 and 2022 and is taking swift action with all active employees involved in the investigation.” Amtrak spokesperson Olivia Irvin
The OIG has identified health care fraud as a high-risk area for Amtrak and continues to monitor the situation closely. Inspector General Winters has emphasized that this investigation should serve as a deterrent for any Amtrak employees or health care providers who might consider engaging in similar schemes in the future. The agency is actively encouraging employees to report any suspected fraud through the Amtrak OIG Hotline or online reporting system, reinforcing that such criminal behavior will not be tolerated within the organization.
