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New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted 02/23/24

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud, Reporting to Government,

Catch of the Week: Lincare, Inc.

Posted 02/16/24

This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country. Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them. DOJ also charged Lincare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case,

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted 01/30/24

Doctor Holding Stethoscope with Crossed Arms

This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid. So here is our look at the Top Ten healthcare recoveries for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Catch of the Week: New York-Presbyterian Hospital

Posted 01/26/24

This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital. Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Posted 01/22/24

Silver Lake Hospital, operating as Columbus LTACH in Newark, New Jersey, and certain investors recently agreed to pay a combined $30.6 million to settle False Claims Act allegations relating to Medicare payments and violations under the Federal Debt Collection Procedures Act (FDCPA). Silver Lake is a long-term care hospital a whistleblower alleged was claiming excessive "cost outlier" payments from Medicare, a...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

Top Ten False Claims Act Recoveries in 2023

Posted 01/11/24

It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Catch of the Week: Moffitt Cancer Center

Posted 01/5/24

This week's Department of Justice (DOJ) Catch of the Week goes to Tampa-based H. Lee Moffitt Cancer Center & Research Institute Hospital. Yesterday (January 4), the non-profit cancer treatment and research center agreed to pay roughly $19.6 million to settle DOJ charges of violating the False Claims Act by billing Medicare for patient care services provided during research studies not eligible for...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Facility, Medical Billing Fraud, Medicare,

Community Health Network Pays $345 Million to Settle Stark Law Case

Posted 12/21/23

Handshake in room with dark window blinds

Community Health Network Inc., based in Indianapolis, recently settled with the U.S. government for $345 million, addressing allegations under the False Claims Act related to the Stark Law. This landmark case emphasizes the importance of whistleblowers to combat Medicare fraud. The Stark Law prevents hospitals from billing Medicare for services referred by physicians who have a financial relationship with the...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case,

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Posted 11/21/23

Person with Magnifying Glass and Pen Examining Stack of Papers

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) just released its 2023 Annual Report on its Top Management and Performance Challenges for the past year. Among the key challenges OIG identified is better protecting HHS programs -- Medicare and Medicaid being chief among them -- from fraud, waste, and abuse. No big surprise as this is a perennial challenge for the federal...

Tagged in: Healthcare Fraud, Medicaid, Medicare,

Caught in the Crosshairs - Department of Veteran Affairs

Posted 11/17/23

As reported this week in Military Times, a group of whistleblowers have complained of significant failings in the Department of Veteran Affairs (VA) suicide prevention hotline. According to the article, the Veterans Crisis Line has rapidly expanded in recent years, growing from roughly 900 employees in 2021 to more than 1,800 employees today. At the same time, however, there has been an equally dramatic rise in...

Tagged in: Other Government Health Programs,

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New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Catch of the Week: Lincare, Inc.

Top Ten Healthcare False Claims Act Recoveries for 2023

Catch of the Week: New York-Presbyterian Hospital

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Top Ten False Claims Act Recoveries in 2023

Catch of the Week: Moffitt Cancer Center

Community Health Network Pays $345 Million to Settle Stark Law Case

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Caught in the Crosshairs - Department of Veteran Affairs

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