Orange Medical Agrees to Pay $600,000 to Resolve FCA Violations Involving Billing for Services Rendered by Non-Credentialed Providers

Today the U.S. Attorney for the Southern District of New York announced a $600,000 settlement to resolve False Claims Act violations with Orange Medical Care, P.C., a family medicine practice based in Newburgh, New York. Orange Medical Care and its owners, Drs. Ashikkumar A. Raval and Manish A. Raval, admitted to submitting claims for primary care services that were not rendered or supervised by the physician identified in the claim for payment. Instead, these services were performed by non-credentialed providers, including nurse practitioners and physician assistants. On many occasions the doctors were not even present in the United States when the services were rendered.

As initially alleged in the complaint, the fraud spanned from late 2006 through late 2022, during which time Orange Medical and the Ravals systematically submitted claims that falsely listed one of the Raval doctors as the rendering provider. Orange Medical submitted these claims even though the actual services were provided by non-physician providers who were not enrolled in the Medicare or Medicaid programs. Even more troubling, the Raval doctors frequently altered patient records to falsely indicate their involvement in patient care.

Prior to the settlement, there was an extensive investigation led by the Department of Health and Human Services, Office of Inspector General. Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office announced, “…the defendants acknowledged that Orange Medical obtained funds from the Medicare and Medicaid programs for claims that did not comply with those programs’ billing rules.”

Similarly, U.S. Attorney Damian Williams said, “Orange Medical and the Ravals submitted false claims to Medicare and Medicaid, failing to accurately identify who was involved in their patients’ treatment. This Office is committed to ensuring that individuals and entities billing federal health care programs do so in an honest manner.”

Under the settlement agreement, Orange Medical and the Ravals will pay $268,800 to the U.S. and $331,200 to the State of New York. The settlement amount reflects an ability to pay assessment. Additionally, the parties have executed a Consent Judgment for $1,646,835, which may be enforced if they fail to make the required payments under the settlement agreement.

If you have information about potential Healthcare Fraud or would like to learn more about what it takes to become a whistleblower, you can speak to an experienced Constantine Cannon whistleblower lawyer team member. Please don’t hesitate to contact us for a free and confidential consultation.