08/19/2024 | Press release | Distributed by Public on 08/19/2024 10:07
Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office of the Department of Health and Human Services, Office of Inspector General ("HHS-OIG"), announced today that the United States has filed and simultaneously settled a civil fraud lawsuit against ORANGE MEDICAL CARE, P.C. ("ORANGE MEDICAL") and its owners, ASHIKKUMAR A. RAVAL and MANISH A. RAVAL (together, the "RAVALS" and with ORANGE MEDICAL, the "Defendants").
The RAVALS are physicians who own and operate ORANGE MEDICAL, a family medicine practice that provides primary care services to patients in Newburgh, New York. The settlement resolves claims that ORANGE MEDICAL and the RAVALS fraudulently billed Medicare and Medicaid by submitting claims for primary care services that were not rendered or supervised by the physician identified in the claim for payment and had, in fact, been rendered by non-credentialed providers.
Under the settlement approved Saturday, August 17, 2024, by U.S. District Judge Paul Gardephe, ORANGE MEDICAL and the RAVALS will pay $268,800 to the U.S. and have admitted and accepted responsibility for conduct alleged in the Complaint as further described below. ORANGE MEDICAL and the RAVALS have also agreed to pay $331,200 to the State of New York to resolve the State of New York's claims, for a total recovery of $600,000. The settlement amount is based on the Office's and the State of New York's assessment of ORANGE MEDICAL's and the RAVALS' ability to pay based on the financial information they provided. The parties have also executed a Consent Judgment in the amount of $1,646,835, which may be enforced if the Defendants do not make the payments required under the settlement agreement.
U.S. Attorney Damian Williams said: "Orange Medical and the Ravals submitted false claims to Medicare and Medicaid, failing to accurately identify who was involved in their patients' treatment. This Office is committed to ensuring that individuals and entities billing federal health care programs do so in an honest manner."
HHS-OIG Special Agent in Charge Naomi Gruchacz said: "As a part of this settlement, the defendants acknowledged that Orange Medical obtained funds from the Medicare and Medicaid programs for claims that did not comply with those programs' billing rules. Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients."
As alleged in the Complaint filed in Manhattan federal court:
From November 2006 through December 2022, ORANGE MEDICAL and the RAVALS submitted claims to Medicare and Medicaid that listed one of the RAVALS as the rendering provider even though the services had been rendered by non-credentialed providers, without the direct supervision of the RAVALS. On many such occasions, the RAVALS were traveling outside of the U.S. at the time the patient received the treatment.
As part of the settlement, ORANGE MEDICAL and the RAVALS admitted and accepted responsibility for certain conduct alleged by the U.S., including the following:
In connection with the filing of the lawsuit and settlement, the Government joined a private whistleblower lawsuit that had been filed under seal pursuant to the False Claims Act.
* * *
Mr. Williams praised the outstanding investigative work of HHS-OIG, and he thanked the Medicaid Fraud Control Unit at the New York State Attorney General's Office for its extensive collaboration in the investigation and resolution of this case.
The case is being handled by the Office's Civil Frauds Unit. Assistant U.S. Attorney David E. Farber is in charge of the case.