A New York physician is set to be sentenced on June 26 for his involvement in a scheme that led to the submission of over $24 million in fraudulent Medicare claims. The Department of Justice has accused him of organizing testing events at various assisted living communities, a retirement community, and adult day centers, resulting in this massive fraud. If convicted, he could face several decades behind bars.
According to the Justice Department, Dr. Alexander Baldonado, a 69-year-old physician from Queens, NY, has been accused of authorizing numerous cancer genetic tests and other laboratory tests for Medicare beneficiaries who participated in COVID-19 testing events at long-term care facilities in 2020. It is alleged that he did not have any involvement in the treatment of the individuals who attended these events and, in many instances, did not even communicate with or examine them before ordering the tests. Additionally, the DOJ claims that Baldonado fraudulently billed Medicare for extended office visits that he never actually conducted for these individuals.
According to a press release from the Justice Department, multiple Medicare patients, who had cancer genetic tests ordered by Baldonado and were billed for office visits, testified during the trial that they were not familiar with Baldonado and had never interacted with him in any way. It was revealed that Baldonado did not follow up with the patients after the testing to discuss the results of the cancer genetic tests, and in certain instances, the patients never received the test results.
The Justice Department revealed that Baldonado not only conducted the lab test scheme but also accepted illegal cash kickbacks and bribes from the owner of a durable medical equipment supply company. In return for these payments, Baldonado would order medically unnecessary orthotic braces for Medicare and Medicaid beneficiaries. During the trial, an undercover video was presented, which allegedly depicted Baldonado receiving a significant amount of cash in exchange for signed prescriptions for orthotic braces.
“The medically unnecessary laboratory tests and orthotic braces that Baldonado ordered in exchange for illegal kickbacks and bribes caused Medicare to be billed more than $24 million,” the Justice Department said. “Medicare paid more than $2.1 million to the laboratories and the durable medical equipment supply company involved in the schemes.”
Baldonado was convicted on Monday for a total of 10 charges. These charges include conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to defraud the United States and to pay, offer, receive and solicit healthcare kickbacks, conspiracy to defraud the United States and to receive and solicit healthcare kickbacks, and solicitation of healthcare kickbacks.
The defendant could potentially receive a maximum prison sentence of 10 years for each count of conspiracy to commit healthcare fraud, healthcare fraud, and solicitation of healthcare kickbacks. Additionally, he could face up to five years in prison for each count of conspiracy to defraud the United States and to pay, offer, receive, and solicit healthcare kickbacks, as well as conspiracy to defraud the United States and to receive and solicit healthcare kickbacks. Ultimately, the length of his sentence will be determined by a federal district court judge.
The case was investigated by the Department of Health and Human Services Office of Inspector General and the FBI.
