Consumer Fraud

Whistleblower Complaint Leads to Multiple Arrests In Massive Health care Fraud Scheme

Pills Stethascope on Money 435x289 Whistleblower Complaint Leads to Multiple Arrests In Massive Health care Fraud SchemeA False Claims Act lawsuit filed by a whistleblower and resulting investigation of those claims has led to the arrest of a New York City-area cardiologist, neurologist, and several others on charges of health care fraud, identity theft, and making false statements, among other things, as well as civil allegations that they defrauded Medicare, Medicaid, and private health insurance companies.

Preet Bharara, the U.S. Attorney for the Southern District of New York, and other federal officials announced the charges March 1, saying that the defendants’ wrongdoing spanned 12 years starting in 2003 and cost taxpayers and private insurers more than $50 million. The U.S. government said it would seek treble damages under the False Claims Act, meaning that the defendants could be on the hook for $150 million.

The Department of Justice (DOJ) determined a board-certified interventional cardiologist who was the president and owner of City Medical Associates, a cardiology and neurology clinic based in Bayside, New York, orchestrated the massive health care fraud scheme, the complaint alleges.

Also participating in the scheme were others employed by City Medical Associates, the U.S. alleges, including the doctor’s nephew, brother, City Medical Associates employees, and a board-certified neurologist with his own practice in Westchester, New York.

The U.S. accuses the defendants of making false representations to insurance providers, including providers paid through Medicaid and Medicare, about the medical condition of patients in order to obtain preauthorization for medical tests and procedures

The U.S. also alleges the defendants submitted false claims to insurance providers for tests and procedures that were not performed or were not medically unnecessary, as well as for drugs and other items that were never used or provided.

Additionally, the defendants paid “exorbitant kickbacks” to local primary care medical offices in exchange for profitable referrals, federal prosecutors contend.

The defendants also accessed the electronic health records of patients at a particular Long Island hospital without authorization in order to identify patients that could be recruited to City Medical Associates, the U.S. alleges.

“As alleged, these defendants that included a cardiologist and neurologist ran a medical practice that for years bilked public health care programs and private insurance companies of more than $50 million,” Bharara said. “Thanks to the hard work of federal and state investigators, this fraud has been revealed and the alleged perpetrators forced to face the consequences of their actions.”

Source: Manhattan U.S. Attorney Preet Bharara