A Hudson Valley medical group that treats cancer patients has agreed to settle a Medicare-related civil fraud lawsuit for $5.31 million, according to U.S. Attorney for the Southern District Preet Bharara announced Friday.
The settlement resolves claims brought under the False Claims Act, alleging Hudson Valley Hematology Oncology Associates routinely waived co-payments and then fraudulently billed Medicare for the co-payments, in addition to submitting false claims for services that it did not provide or were not permitted under the Medicare and Medicaid program rules, Bharara said.
Operating under the new name, Hudson Valley Cancer Center, the physician-owned practice has offices in Yorktown, Hawthorne, Fishkill, Mount Kisco, Carmel and Poughkeepsie.
“Hudson Valley Hematology Oncology Associates improperly billed Medicare and Medicaid for reimbursement, costing the taxpayers millions of dollars," Bharara said. "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.”
The investigation, initiated by a complaint filed by a whistleblower, found the practice over-billed for evaluation and management services codes, in addition to billing for routine procedures (such as chemotherapy or injections) on the same date, even though they had not documented that a doctor provided any evaluation or if they were medically necessary, the complaint said.
In addition, the business was also accused of falsifying records by indicating procedures where performed by doctors when they were performed by nurses.
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