New York Doctor Receives Seven-Year Prison Sentence for $24M Medicare Fraud

By the Constantine Cannon Whistleblower Team

The government remains persistent in its efforts to combat healthcare fraud, actively pursuing and prosecuting those who exploit the system. This ongoing commitment is evident in its recent enforcement actions, including the case we are analyzing in this post.

New York doctor Alexander Baldonado, M.D., 69, received a seven-year prison sentence for submitting more than $24 million in fraudulent Medicare claims for medically unnecessary lab tests and orthotic braces. The court also ordered Baldonado to pay $2,210,384 in restitution.[1]

Alleged Lab Testing Scheme

According to court documents and trial evidence, Baldonado accepted tens of thousands of dollars in illegal cash kickbacks and bribes for ordering lab tests, including expensive cancer genetic tests. Two New York laboratories billed Medicare for those tests.[2]

Baldonado allegedly authorized numerous cancer genetic tests at COVID-19 testing events held in 2020 at assisted living facilities, adult day care centers, and a retirement community. He ordered these tests for Medicare beneficiaries he did not treat and with whom he had no established physician-patient relationship.[3]

Fraud, Kickbacks, and Bribes

The medically unnecessary lab tests and orthotic braces Baldonado ordered in exchange for illegal kickbacks and bribes resulted in more than $24 million in false bills to Medicare. Medicare paid more than $2.2 million on these fraudulent claims. Trial evidence included an undercover video showing Baldonado receiving large cash amounts for signed prescriptions. [4]

Evidence also showed that Baldonado billed Medicare for extensive office visits that never occurred. Several Medicare patients testified that they did not know Baldonado and had never met or spoken with him. After the testing events, Baldonado did not follow up with patients to discuss the test results, and some patients never received results at all.

What Happened After the Jury Trial?

Following a five-day jury trial in February 2025, the jury convicted Baldonado of one count of conspiracy to commit healthcare fraud, six counts of healthcare fraud, one count of conspiracy to defraud the United States and engage in healthcare kickbacks, another count of conspiracy to defraud the United States by receiving and soliciting healthcare kickbacks, and one count of soliciting healthcare kickbacks.[5]

Blowing the Whistle on Healthcare Fraud

While it is unknown whether a whistleblower was involved in initiating this case, whistleblowers can be instrumental in sharing important information with the government to help combat fraud.

Qui Tam Provisions of the False Claims Act

The qui tam provisions of the False Claims Act enable private individuals to file lawsuits on the government’s behalf against those committing fraud. Such fraud can include violations of the Anti-Kickback Statute and Stark Law. In return, whistleblowers may receive up to 30% of the funds recovered by the government.

Whistleblowers initiate most False Claims Act cases, helping the government recover tens of billions of dollars over the years. They are particularly crucial in cases involving kickback violations, as their insider knowledge is often essential for uncovering these schemes.

Our Firm Helps Healthcare Fraud Whistleblowers

Constantine Cannon has significant experience working with whistleblowers to bring False Claims Act cases involving kickbacks or healthcare fraud. According to Constantine Cannon partner Marlene Koury, “Our firm has several groundbreaking successes in this area, with more than a billion dollars recovered for the government and our whistleblower clients.”

To learn more about what it means to be a False Claims Act whistleblower or if you believe you have a case, please contact us for a free and confidential consultation with a member of our whistleblower team.

Speak Confidentially With Our Whistleblower Attorneys

Sources:

[1] See https://www.justice.gov/opa/pr/doctor-sentenced-seven-years-prison-24m-medicare-fraud

[2] Id.

[3] Id.

[4] Id.

[5] Id.

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare,