Hudson Valley Hematology Oncology Associates of Poughkeepsie, N.Y., will pay $5.31 million to settle a False Claims Act lawsuit brought by a whistleblower who accused the group of widespread Medicare and Medicaid fraud.
According to the whistleblower complaint, Hudson Valley Hematology Oncology Associates illegally waived co-payments from Medicare beneficiaries, and then billed the Medicare program for those losses by adding them to other charge submitted for reimbursement.
Federal and state prosecutors also alleged that the medical group overbilled Medicare and Medicaid for evaluation and management services and related routine procedures, such as chemotherapy, injections, or venipunctures, on the same date.
In many cases, Hudson Valley Hematology Oncology Associates billed the government health care programs for services under codes indicating the services were performed by physicians when they were really performed by nurses. This practice allowed the medical group to collect higher reimbursements from Medicare and Medicaid, prosecutors claimed.
The government also alleged that Medicare and Medicaid paid for services that were not medically necessary or never actually performed.
“Hudson Valley Hematology Oncology Associates improperly billed Medicare and Medicaid for reimbursement, costing the taxpayers millions of dollars,” Manhattan U.S. Attorney Preet Bharara said in a statement. “This settlement not only restores those funds, but involves detailed admissions by Hudson Valley and the imposition of safeguards to ensure against fraudulent billing in the future.”
Prosecutors alleged that the fraudulent activity occurred over a five-year period beginning in 2010.
Lucille Abrahamsen, a former employee of Hudson Valley Hematology Oncology Associates filed the lawsuit in 2014 under the whistleblower provisions of the False Claims Act, which authorizes private parties to sue on behalf of the federal government in certain cases of suspected fraud targeting taxpayer-funded agencies and programs.
Federal and state prosecutors investigated the allegations and chose to intervene in the case, meaning they became active litigants. Ms. Abrahamsen is set to receive between $796,500 and $1.06 million as a whistleblower award for her role in helping the government recover the health care funds.