Medical Doctor Charged for $20.7M Healthcare Fraud and Illegal Kickback Schemes

A federal grand jury in New Jersey returned a superseding indictment charging a medical doctor with allegedly engaging in a health care fraud and illegal kickback scheme that involved the submission of over $20.7 million in false and fraudulent claims to Medicare for laboratory tests, including cancer genetic tests. 

According to court documents, Alexander Baldonado, 68, of Queens, New York, allegedly received cash kickbacks from a laboratory representative and others in exchange for approving orders for laboratory tests billed to Medicare. As part of the scheme, Baldonado also allegedly participated in COVID-19 testing events at which he authorized COVID-19 tests as well as expensive and medically unnecessary cancer genetic tests that patients did not request, that were not used in the patient’s treatment, and for which the patients rarely received the results. Baldonado also allegedly billed Medicare for lengthy office visits that he never provided to these patients.   

In addition, Baldonado allegedly engaged in a scheme to defraud Medicare and Medicaid 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.

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. If convicted, he faces a maximum penalty of 10 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. A federal district judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Acting Assistant Attorney General Nicole M. Argentieri 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 Assistant Director in Charge James Smith of the FBI New York Field Office made the announcement.

HHS-OIG and FBI are investigating the case.

Assistant Chief Rebecca Yuan and Trial Attorney Hyungjoo Han of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes.  More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.