A New York doctor has been charged in a superseding indictment in connection with an alleged genetic cancer screening and COVID-19 testing scam. Such an indictment adds information or evidence, as well as charges or defendants to an existing case.
Alexander Baldonado of Queens was indicted on charges he engaged in a genetic testing and COVID-19 healthcare fraud and illegal kickback scheme involving the submission of more than $20.7 million in fraudulent claims to Medicare for laboratory tests.
He originally was charged as part of a coordinated law enforcement action in May 2021 that involved 14 defendants in seven federal districts who took part in various healthcare fraud schemes that exploited the COVID-19 pandemic and resulted in more than $143 million in false billings.
According to the indictment issued last month, Baldonado received cash kickbacks from a representative of a laboratory in exchange for approving orders for lab tests that were billed to Medicare.
COVID-19 Healthcare Fraud Scheme
The alleged scheme started in September 2020 during the global COVID pandemic. The U.S. Department of Justice alleges that Baldonado and co-conspirators obtained access to Medicare patients by offering COVID-19 tests to residents of a retirement community.
In addition to offering COVID testing, Baldonado also allegedly ordered cancer genetic testing even though he was not treating the patients for cancer or symptoms of the disease. The indictment states that Baldonado signed requisition forms certifying that the tests were medically necessary and that the results would be used in the management and treatment of the patients.
Not only that, but it’s also alleged that he and his unnamed co-conspirators added false information about the patients’ personal and family history of cancer to make it look like the tests were justified.
Hiding Ill-Gotten Gains
To hide the illegal kickbacks in this genetic testing and COVID-19 healthcare fraud scheme, Baldonado received the payments in cash and identified them as payments for rent or loans. In total, he caused two lab companies to submit more than $20.7 million in false claims to Medicare for tests that either were not medically necessary, not eligible for reimbursement, or not even conducted.
The two lab companies were paid around $2 million based on the false claims.
Baldonado is charged with one count of conspiracy to commit healthcare fraud, six counts of healthcare fraud, two counts of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and one count of soliciting healthcare kickbacks.
If convicted, he faces a maximum penalty of 10 years in prison for each count of conspiracy to commit healthcare fraud, healthcare fraud, and soliciting healthcare kickbacks, and a maximum penalty of five years in prison on each count of conspiracy to defraud the United States and pay and receive healthcare kickbacks.
Battling COVID-19 Fraud
In May 2021, the government launched the COVID-19 Fraud Enforcement Task Force in response to the growing number of healthcare fraud causes growing out of the pandemic.
From the beginning of the pandemic public health emergency in March 2020 through June 2023, approximately 1,399 individuals or businesses were “found guilty or liable” in pandemic-related fraud cases, according to the U.S. Government Accountability Office (GAO).
The Centers for Medicare & Medicaid, in 2022, issued a White Paper on “Fraud, Waste and Abuse in the Context of COVID-19.” In the paper, the authors discuss how fraud schemes have adapted to the changes in the healthcare environment in light of the pandemic. The paper outlines the different schemes that grew out of the COVID-19 pandemic.
In February 2023, the U.S. Department of Health and Human Services issued a COVID-19 fraud alert urging Medicare patients to be wary of scammers and offering ways to protect themselves.
How We Can Help
The Health Law Offices of Anthony C. Vitale represents healthcare professionals in state and federal court who are charged with fraudulent billing, illegal kickbacks, Medicare and Medicaid fraud, and false claims, among others. For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com
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