Thursday, November 7, 2013

Mid-Hudson Medical Group to Pay $5 Million in Health Care Fraud Settlement

Mid-Hudson Medical Group to Pay $5 Million in Health Care Fraud Settlement
HUDSON VALLEY, N.Y. – The medical group that employed Spyros Panos, the Hopewell Junction surgeon who pleaded guilty last week to felony health care fraud, will pay the United States $5 million as part of a federal settlement agreement.
Preet Bharara, U.S. attorney for the Southern District of New York, said in a news release that the Mid-Hudson Medical Group (MHMG), which has offices throughout Dutchess and Putnam counties, received millions of dollars from two schemes to defraud Medicare, the New York State Insurance Fund, and other private health insurance providers. The settlement agreement was submitted to U.S. District Judge Vincent L. Briccetti Wednesday afternoon.
“The laws are clear and formidable when it comes to the bilking of health insurance providers: you cannot be permitted to keep and enjoy illicit proceeds of fraud,” Bharara said.
According to the complaint and other publicly filed documents, between at least 2006 and July 2011, Panos engaged in an unlawful scheme to defraud health insurance providers, where he and MHMG submitted fraudulent information regarding the nature and details of surgical procedures he performed. As a result, the insurance companies paid MHMG millions of dollars more than it was entitled to receive for the actual work that Panos performed.
On Oct. 31, Panos pleaded guilty to one count of engaging in a scheme to commit health care fraud.
Court documents also state that from approximately 2009 through June 2012, some employees at MHMG submitted requests to insurance companies that, in some cases, contained false information about patients. As a result the insurance companies paid MHMG more for MRI tests than the medical group was entitled to receive.
Under the terms of the settlement, MHMG is awarded credits for reimbursements it has already made to certain health insurance providers. The medical group is also required to transfer an additional $3.67 million to the United States in accordance with an agreed-upon schedule.
The settlement represents an estimate of the amount of proceeds MHMG obtained from health insurance providers as a result of the alleged fraud.
Panos faces up to 10 years in prison and owes millions of dollars after admitting to running a scheme that defrauded health insurance providers.

No comments:

Post a Comment