Physician Sentenced for $24M Medicare Fraud in Cancer Testing Scheme

A physician, Alexander Baldonado, MD, was sentenced to seven years in prison for orchestrating a large-scale Medicare fraud scheme involving medically unnecessary cancer genetic tests and orthotic braces. Baldonado submitted over $24 million in fraudulent claims to Medicare, primarily targeting beneficiaries who attended COVID-19 testing events at assisted living communities without providing medical treatment or consultation. He was also ordered to pay $2.2 million in restitution as a result of the scheme. Court evidence revealed that Baldonado received cash kickbacks and bribes in exchange for ordering expensive laboratory tests and orthotic braces, which were billed to Medicare by labs and durable medical equipment companies. Many Medicare beneficiaries subjected to these tests and office visit charges testified that they had no contact with Baldonado and did not receive results for the tests ordered in their name. Baldonado’s fraudulent practices included billing for office visits never conducted, and in some instances, the beneficiaries never received test results, highlighting systemic vulnerabilities in Medicare’s oversight of laboratory services and medical equipment billing. The scheme exploited COVID-19 testing events to gain access to Medicare beneficiaries, reflecting challenges in compliance and verification during public health emergencies. Following a jury trial, Baldonado was convicted of multiple counts including conspiracy to commit healthcare fraud, healthcare fraud, and conspiracy to pay and receive healthcare kickbacks. This case underscores ongoing regulatory emphasis on combating fraud in medical billing and the importance of rigorous documentation and beneficiary verification to protect federal healthcare programs. The sentencing and restitution order reflect the judiciary’s role in enforcing compliance and deterring fraudulent practices that inflate Medicare costs. This case highlights the need for continuous vigilance among payers and providers regarding the authenticity of claims and the legal consequences of fraudulent activities within the Medicare program.