Hudson Valley Oncology Medicare Fraud Exposed by Whistleblower Medical Coder: $5.31MM Settlement

Hudson Valley Hematology Oncology Associates will pay the government $5.31 million to resolve allegations in a whistleblower lawsuit that it systematically billed Medicare and Medicaid for ineligible and non-existent services.

Hudson Valley Oncology Medicare Fraud Exposed by Whistleblower Medical Coder: $5.31MM Settlement

Between 2010 and 2015, Hudson Valley was allegedly involved in two different fraudulent schemes. On the one hand, it waived Medicare beneficiaries’ copayments and billed Medicare instead. On the other hand, it routinely billed both Medicare and Medicaid for services that were either not performed or not medically necessary. 

Whistleblower Lucille Abrahamsen: Medical Coder Hudson Valley Employee

Hudson Valley’s wrongdoing was first brought to light by Lucille Abrahamsen, a resident of  Highland, New York,  who filed a lawsuit under the False Claims Act in April, 2014. Abrahamsen became aware of her employer’s improper billing practices while working for them as a medical coder.

Her allegations quickly led to a federal investigation, and the government rapidly joined as a new plaintiff in Lucille Abrahamsen’s qui tam lawsuit.

By law, whistleblowers who sue fraudsters under the False Claims Act, are entitled to a percentage of any moneys recovered by the authorities. As a result of the recent settlement, Abrahamsen is set to receive between 15 and 20 percent of the multi-million dollar recovery.

Hudson Valley Hematology Oncology Associates Admits Illegal Conduct

But there is more to gain from the lawsuit’s resolution than mere cash. As the DOJ fights more fiercely to obtain admissions of guilt from dishonest healthcare providers, more and more defendants are beginning to admit their responsibility in cases of Medicare and Medicaid fraud. 

As part of its agreement with the government, Hudson Valley Hematology Oncology Associates admitted, acknowledged, and accepted responsibility for various types of misconduct taking place between 2010 and 2015. According to the Stipulation and Order of Settlement and Dismissal, during the covered time period, Hudson Valley:

“Routinely waived Medicare beneficiaries’ copayments applicable to CTP codes 99211-99215, without an individualized documented determination of financial hardship or exhaustion of reasonable collection efforts;”

“Billed Medicare for the waived copayments, resulting in higher reimbursement amounts from Medicare than Hudson Valley was entitled to;”

“Overbilled Medicare and Medicaid for evaluation and management services (CTP 99211 or 99212 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”

“Billed Medicare and Medicaid for evaluation and management services (code 99211 and 99212) without documenting in the medical record that those services were medically necessary and/or that those services were actually performed.”

U.S. Attorney Bharara says Safeguards to Prevent Future Hudson Valley Schemes

Commenting on the settlement, Manhattan U.S. Attorney Preet Bharara referred to the healthcare provider’s violations, “Hudson Valley Hematology Oncology Associates improperly billed Medicare and Medicaid for reimbursement, costing the taxpayers millions of dollars. 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.”

In times of spiraling healthcare costs, the uncovering of fraud against taxpayer-funded programs like Medicaid and Medicare becomes a thing to celebrate. Courageous whistleblowers continue to expose all manner of fraud, billing schemes, and other illegal misconduct by healthcare providers, who are entrusted with the health and well-being of the American people. 

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