More doctors being investigated for fraud

By Alex P. Vidal

“The more you sweat in practice, the less you bleed in battle.” –  E. Lockhart, Genuine Fraud

THE case of a 70-year-old Filipino doctor from Queens, New York City convicted of medical fraud is reportedly not isolated.

The U.S. Department of Justice is also investigating other cases involving fraudulent transactions to Medicare, sources said.

This developed after Dr. Alexander “Alex” Baldonado was sentenced to seven years in prison after being found guilty in February this year by a federal jury for causing the submission of over $24 million in fraudulent claims to Medicare for medically unnecessary laboratory tests and orthotic braces.

The U.S. Department of Justice had presented court documents and evidence during Baldonado’s trial showing he received tens of thousands of dollars in illegal cash kickbacks and bribes in exchange for ordering laboratory tests, including expensive cancer genetic tests, that were billed to Medicare by two related laboratories located in New York.

Baldonado authorized hundreds of cancer genetic tests for Medicare beneficiaries who attended COVID-19 testing events at assisted living facilities, adult day care centers, and a retirement community in 2020 as part of the scheme, according to court documents.

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The U.S. Department of Justice said Baldonado was not treating any of the patients who attended the testing events and, in many cases, did not speak to or examine the patients prior to ordering cancer genetic tests and other laboratory tests for them.

Baldonado also reportedly billed Medicare for lengthy office visits that he never provided to these patients.

Several Medicare patients for whom Baldonado ordered cancer genetic tests and billed for office visits testified at trial that they did not know who Baldonado was and had never met or spoken to him. Baldonado also reportedly did not contact the patients after the testing events to review the results of the cancer genetic tests, and, in some cases, the patients never received the test results.

Baldonado also reportedly received illegal cash kickbacks and bribes from the owner of a durable medical equipment supply company in exchange for ordering medically unnecessary orthotic braces for Medicare and Medicaid beneficiaries in addition to the laboratory testing scheme.

It was reported earlier that evidence presented at trial showed Baldonado on an undercover video “receiving a large sum 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, court records said.

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Medicare paid more than $2.1 million to the laboratories and the durable medical equipment supply company involved in the schemes.

Baldonado was found guilty of one count of conspiracy to commit health care fraud; six counts of health care fraud; one count of conspiracy to defraud the United States and to pay, offer, receive, and solicit health care kickbacks; one count of conspiracy to defraud the United States and to receive and solicit health care kickbacks; and one count of solicitation of health care kickbacks. Following his conviction on the 10 counts, Baldonado was remanded to the custody of the U.S. Marshals Service.

After his sentencing, he now faces a maximum penalty of seven to 10 years in prison on each count of conspiracy to commit health care fraud, health care fraud, and solicitation of health care kickbacks and five years in prison on each count of conspiracy to defraud the United States and to pay, offer, receive, and solicit health care kickbacks and conspiracy to defraud the United States and to receive and solicit health care kickbacks.

A federal district court judge determined the sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Supervisory Official Antoinette T. Bacon of the Justice Department’s Criminal Division, Special Agent in Charge Naomi Gruchacz of the Department of Health and Human Services Office of Inspector General (HHS-OIG) and Acting Special Agent in Charge Terence G. Reilly of the FBI Newark Field Office made the announcement.

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HHS-OIG and FBI investigated the case. Assistant Chief Rebecca Yuan and Trial Attorney Hyungjoo Han of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section led the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program.

Since March 2007, the program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion.

In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes, according to the U.S. Department of Justice.

(The author, who is now based in New York City, used to be the editor of two leading daily newspapers in Iloilo, Philippines.—Ed)