A New York doctor is spending the holidays in prison, having merited a seven-year jail term for submitting more than $24 million in fraudulent Medicare claims for medically unnecessary laboratory tests and orthotic braces. He also must pay $2,210,384 in restitution.

According to court documents and evidence presented at trial, Queens resident Alexander Baldonado, M.D., 69, received tens of thousands of dollars in illegal cash kickbacks and bribes in exchange for ordering laboratory tests—including expensive cancer genetic tests—that were billed to Medicare by two New York-based laboratories.

As part of the scheme, Dr. Baldonado authorized hundreds of cancer genetic tests for Medicare beneficiaries who attended COVID-19 testing events in 2020 at assisted living facilities, adult day care centers, and a retirement community. Dr. Baldonado was not treating any of the patients who attended the testing events and, in many cases, did not speak to or examine the patients before ordering cancer genetic tests and other lab assays for them. Dr. Baldonado also billed Medicare for lengthy office visits that he never provided to these patients. Several Medicare patients for whom Dr. Baldonado ordered cancer genetic tests and billed for office visits testified they did not know Dr. Baldonado and had never met or spoken to him. The defendant did not contact the patients after the testing events to review the cancer genetic test results, and, in some cases, the patients never received the results.

In addition to the laboratory testing scheme, Dr. Baldonado also received illegal cash kickbacks and bribes from a durable medical equipment supply company owner in exchange for ordering medically unnecessary orthotic braces for Medicare and Medicaid beneficiaries. The evidence presented at trial showed Dr. Baldonado on an undercover video receiving a large sum of cash in exchange for signed prescriptions for orthotic braces.

The medically unnecessary laboratory tests and orthotic braces that Baldonado ordered in exchange for illegal kickbacks and bribes caused Medicare to be billed more than $24 million. Medicare paid over $2.2 million based on these false and fraudulent claims, according to federal prosecutors.

After a five-day trial in February, a jury found Dr. Baldonado guilty of one count of conspiracy to commit healthcare fraud; six counts of healthcare fraud; one count of conspiracy to defraud the United States and to pay, offer, receive, and solicit healthcare kickbacks; one count of conspiracy to defraud the United States and to receive and solicit healthcare kickbacks; and one count of solicitation of healthcare kickbacks.

Acting Assistant Attorney General Matthew R. Galeotti of the Justice Department’s Criminal Division; Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services, Office of Inspector General (HHS-OIG); and Special Agent in Charge James E. Dennehy of the FBI Newark Field Office made the announcement.

HHS-OIG and FBI investigated the case and Acting Principal Assistant Chief Rebecca Yuan of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section leads the Criminal Division’s efforts to combat healthcare 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 5,800 defendants who collectively have billed federal healthcare programs and private insurers over $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes.