Alexander Baldonado, a medical doctor in New York, was recently charged via a grand jury superseding indictment with engaging in a health care fraud and illegal kickback scheme involving more than $20 million in false and fraudulent claims to Medicare for laboratory tests. According to the allegations, Baldonado received kickbacks from a laboratory representative and others in exchange for approving orders for laboratory tests that were billed to Medicare. In addition, Baldonado also allegedly participated in COVID-19 testing events, at which he authorized COVID-19 tests and expensive and medically unnecessary cancer genetic tests. The cancer genetic tests were not requested by the patients, were not used in the patient’s treatment, and the patient often did not even receive the results. Baldonado also allegedly billed Medicare for office visits that were never provided.
One example provided in the superseding indictment was from in or around September 2020, when Baldonado allegedly solicited and received a roughly $4,000 cash kickback in exchange for signing cancer genetic testing laboratory requisition forms for Medicare beneficiaries.
In addition to those allegations, Baldonado also allegedly engaged in a scheme to defraud federal health care programs by soliciting – and receiving – cash kickbacks and bribes from an owner of a durable medical equipment supply company in exchange for ordering orthotic braces that were medically unnecessary and ineligible for reimbursement.
Several examples provided in the superseding indictment include a $2,500 cash kickback in or around September 2020 in exchange for orthotic brace orders and referrals; a $2,500 cash kickback in or around October 2020 in exchange for orthotic brace orders and referrals; and a $2,500 cash kickback in or around April 2021 in exchange for orthotic brace orders and referrals.
While the examples provided in the indictment largely seemed to come during the COVID-19 public health emergency, the allegations go back to before the COVID-19 pandemic, possibly as early as 2018.
Under the superseding indictment, Baldonado is charged with one count of conspiracy to commit health care fraud, six counts of health care fraud, two counts of conspiracy to defraud the United States and pay and receive health care kickbacks, and one count of soliciting health care kickbacks. He faces a maximum penalty of ten years in prison for each count of conspiracy to commit health care fraud, health care fraud, and soliciting health care kickbacks, and a maximum penalty of five years in prison on each count of conspiracy to defraud the United States and pay and receive health care kickbacks.