Features, Finance, Health and Safety, Law and Politics, New York

False Medicare Billing Costs NYS Millions

September 2, 2018

By Stephanie West

WHITE PLAINS, NY – A fraudulent operation of Dolson Avenue Medical practice (DAM), a multi-disciplinary medical clinic located in Middletown, New York, has cost New York State millions.

Those indicted for participating in a widespread health care fraud scheme include JAMES SPINA, JEFFREY SPINA, ANDREA GROSSMAN, and KIMBERLY SPINA.  From 2011 through September 2017, DAM was a registered medical service corporation in New York state that purported to provide a variety of pain management and rehabilitation services.The group showed little regard for whether the services were actually provided to patients, and instead  billed insurance providers to maximize DAM’s reimbursements.They submitted claims to insurance providers for medically unnecessary services and  altered and fabricated medical records.

New York State Comptroller Thomas P. DiNapoli said: “The Spinas and their associates allegedly swindled tens of millions of dollars by fraudulently billing health insurers including the NYS Health Insurance Program and the State Insurance Fund. An alleged theft of this magnitude is appalling when so many hard-working people experience rising health care costs. Now, their alleged scams have been exposed, thanks to my partnership with U.S. Attorney Berman, the FBI, the U.S. Department of Health and Human Services Inspector General and the Orange County Sheriff’s Office.”

The majority of the claims submitted by DAM and the their associated businesses to Medicare and other insurance providers were false and fraudulent. The  claims totaled more than $80,000,000, resulting in losses of tens of millions of dollars.

September 2, 2018

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