Two Newburgh doctors and their medical practice have settled a Medicare and Medicaid fraud lawsuit that was initiated by a whistleblower who worked for them.
U.S. Attorney Damian Williams announced the settlement on Aug. 19 requiring Drs. Manish A. Raval and Ashikkumar A. Raval and Orange Medical Care P.C. to repay at least $600,000 of a $1.6 million judgment.
Former employee Niki Patel, an internal medicine physician who worked for Orange Medical Care for more than a year, filed a False Claims Act lawsuit in 2016 that alleged improper billing practices. The U.S. Attorney joined the lawsuit, on behalf of the federal Centers for Medicare & Medicaid Services and New York State.
Orange Medical Care takes a holistic approach to medicine, according to its website, and offers primary care internal medicine services, pediatric and adolescent care, and addiction medicine.
From 2006 through 2022, the civil complaint states, an outside billing company submitted claims to Medicare and Medicaid for services purportedly provided by the Ravals. The services were actually provided by physician assistants or nurse practitioners who were not credentialled by the federal programs and who were not directly supervised by the doctors.
In many instances, according to the complaint, the Ravals were traveling outside of the U.S. when patients were treated, and patient records were altered to make it look like one of the Ravals had provided the services.
The government says the doctors knew the claims were improper. In February 2016, for instance, Ashikkumar Raval instructed the billing company: “Until all the providers are credentialed [Orange Medical] will have to bill under the provider who is credentialed. Please do not hold any billing for that reason.”
The complaint charges the Ravals and their medical practice with presenting false claims for payment, use of false statements, unjust enrichment, and payment by mistake.
The government agreed to accept $600,000, including $268,800 for the federal government and $331,200 for New York State, the co-administrator of the Medicaid program for low-income individuals.
The doctors had consented to a $1,646,835 judgment, but the government agreed to lower the penalty, “due solely to defendants’ financial condition.”
If the government discovers that either doctor misrepresented his net worth by $60,000 or more, the U.S. can reinstate the lawsuit or collect the full $1.6 million settlement. If the doctors default during the repayment schedule, the government can exclude them from all federal health care programs.
The settlement does not say whether Dr. Patel received a reward. Typically, whistleblowers get from 15% to 30% of the funds recovered in successful False Claims Act cases. The settlement also does not explain why it took nearly eight years to resolve the allegations she brought forward in 2016.
The complaint was filed in Manhattan federal court and was endorsed on Aug. 17 by U.S. District Judge Paul G. Gardephe.
