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Monthly round up There have been no updates from the PSR since we last reported, but plenty of FWA activity around the world. FWA around the world New York doctor facing jail following conviction for $24 million Medicare fraud scheme Dr Alexander Baldonado, aged 69, was found guilty by a jury for causing over $24 million fraudulent claims to Medicare which were not medically necessary. The Australian equivalent would be that the services were not “clinically relevant” which is our legal threshold standard. Like the U.S standard, our “clinical relevance” standard also means that all services must be necessary for the treatment of the patient. Our standard therefore operates very similarly to the U.S standard. Dr Baldonado authorised hundreds of unnecessary tests for Medicare patients who attended COVID-19 testing events, but he was not treating any of them and, in many cases, he did not speak to or examine the patients prior to ordering the tests. He also billed Medicare for fictitious consultations and received illegal cash kickbacks and bribes from the owner of a medical equipment company in exchange for ordering medically unnecessary orthotic braces. Dr Baldonado has been remanded in custody and will be sentenced in June 2025. You can read the Department of Justice report here. Louisiana doctor sentenced to 87 months jail for $5.4 million healthcare fraud scheme Dr Adrian Dexter Talbot, aged 59, owned and operated clinics that accepted cash payments for patients seeking controlled substances, such as opioids. He was found to have pre-signed prescriptions for patients he did not see or examine. With...
