Hudson Valley Medical Practice Settles $5.31M Medicare Fraud Lawsuit

YORKTOWN, NY — A medical practice with office throughout the Hudson Valley will pay $5.31 million to settle a civil fraud lawsuit which claimed it fraudulently billed Medicare for copayments which it routinely waived.

Preet Bharara, the U.S. Attorney for the Southern District of New York, said Friday Hudson Valley Hematology Oncology Associates improperly billed Medicare and Medicaid for reimbursement, costing taxpayers millions of dollars.

“This settlement not only restores those funds, but involved detailed admissions by Hudson Valley and the imposition of safeguards to ensure against fraudulent billing in the future,” he said.

Hudson Valley Hematology Oncology Associates has offices in Poughkeepsie, Fishkill, Carmel, Mount Kisco, Hawthorne and Yorktown, according to its website.

The settlement resolves claims brought under the False Claims Act, Bharara said, alleging that the medical practice routinely waived copayments without lawful basis and fraudulently billed Medicare for those copayments.

Also it systematically submitted false claims for services that it did not provide and/or were not permitted under the Medicare and Medicaid program rules.

In addition to repaying the $5.31 million, the medical practice “admits to and accepts responsibility for misconduct alleged in the complaint.”

Additionally, the practice will submit to monitoring by the U.S. Department of Health and Human Services for five years.

From the press release:

As part of the settlement, HUDSON VALLEY admitted, acknowledged, and accepted responsibility for engaging in the following conduct from 2010-2015:

• Routinely waiving Medicare beneficiaries’ copayments without an individualized documented determination of financial hardship or exhaustion of reasonable collection efforts;
• Billing Medicare for the waived copayments, resulting in higher reimbursement amounts from Medicare than HUDSON VALLEY was entitled to;
• Overbilling Medicare and Medicaid for evaluation and management services codes, in addition to billing for routine procedures (such as chemotherapy, injections or venipunctures) on the same date, even though Hudson Valley had not documented that it provided any significant, separately identifiable evaluation and management services to the beneficiaries; and
• Billing Medicare and Medicaid for evaluation and management services codes without documenting in the medical record that those services were medically necessary and/or that those services were actually performed.

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