A New York physician, identified as Doctor M. throughout court documents, was convicted yesterday by a federal jury for orchestrating a massive healthcare fraud scheme. This scheme involved submitting over $24 million in fraudulent claims to Medicare. The claims were for laboratory tests and orthotic braces that were deemed medically unnecessary.
Evidence presented during the trial revealed that Doctor M., 69, based in Queens, accepted substantial illegal cash kickbacks and bribes. These illicit payments were in exchange for Doctor M. ordering various laboratory tests, including costly cancer genetic tests. These tests were then billed to Medicare by two associated laboratories operating in New York.
The fraudulent activities were extensive. Doctor M. reportedly authorized hundreds of cancer genetic tests for Medicare beneficiaries. These beneficiaries were present at COVID-19 testing events held at locations such as assisted living facilities, adult day care centers, and a retirement community in 2020. Crucially, Doctor M. was not the treating physician for any of these patients. In many instances, Doctor M. neither consulted with nor examined the patients before ordering these cancer genetic and other laboratory tests. Furthermore, Doctor M. fraudulently billed Medicare for extended office visits that never occurred for these patients. Testimony from several Medicare patients confirmed they had no knowledge of Doctor M. and had never interacted with this doctor, despite being subjected to these tests. Doctor M. also failed to follow up with patients regarding their cancer genetic test results, and in some cases, patients never received their results.
Beyond the laboratory testing fraud, Doctor M. also engaged in a scheme involving orthotic braces. Doctor M. accepted illegal cash kickbacks and bribes from the owner of a durable medical equipment supply company. This was in exchange for Doctor M. ordering medically unnecessary orthotic braces for Medicare and Medicaid beneficiaries. Undercover video evidence shown at trial depicted Doctor M. receiving a large sum of cash in return for signed prescriptions for orthotic braces.
The cumulative effect of these schemes, involving medically unnecessary laboratory tests and orthotic braces ordered by Doctor M. in exchange for illegal kickbacks and bribes, resulted in Medicare being billed for over $24 million. Medicare disbursed more than $2.1 million to the implicated laboratories and the durable medical equipment supply company.
Following a trial, Doctor M. was found guilty on ten counts. These included conspiracy to commit health care fraud; six counts of health care fraud; conspiracy to defraud the United States and to pay, offer, receive, and solicit health care kickbacks; conspiracy to defraud the United States and to receive and solicit health care kickbacks; and solicitation of health care kickbacks. Upon conviction, Doctor M. was taken into custody by the U.S. Marshals Service. Sentencing is scheduled for June 26th. Doctor M. faces a maximum prison sentence of 10 years for each count of conspiracy to commit health care fraud, health care fraud, and solicitation of health care kickbacks. Additionally, Doctor M. faces five years in prison for each count of conspiracy to defraud the United States related to health care kickbacks. The final sentence will be determined by a federal district court judge, considering U.S. Sentencing Guidelines and other legal factors.
The announcement of the conviction was made by 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.
The investigation was conducted by HHS-OIG and FBI.
The prosecution was handled by Assistant Chief Rebecca Yuan and Trial Attorney Hyungjoo Han of the Criminal Division’s Fraud Section.
The Fraud Section spearheads the Criminal Division’s efforts against health care fraud through the Health Care Fraud Strike Force Program. Since 2007, this program has charged over 5,800 defendants responsible for more than $30 billion in fraudulent billings to federal health care programs and private insurers. The Centers for Medicare & Medicaid Services, alongside HHS-OIG, are actively working to hold accountable providers involved in health care fraud. Further information is available at www.justice.gov/criminal-fraud/health-care-fraud-unit.
