February 25, 2025 | JacobiJournal.com – A New York doctor, Alexander Baldonado, M.D., has been convicted of orchestrating a $24 million Medicare fraud scheme. A federal jury found him guilty of submitting fraudulent claims for medically unnecessary lab tests and orthotic braces.
How the Scheme Worked
Medicare Fraud Scheme: According to court documents and trial evidence, Baldonado received illegal cash kickbacks for ordering unnecessary cancer genetic tests and orthotic braces. These fraudulent claims were billed to Medicare by two New York-based laboratories.
In 2020, Baldonado authorized hundreds of cancer genetic tests for Medicare patients at COVID-19 testing events in assisted living facilities, adult day care centers, and a retirement community. However, he never treated or examined these patients before ordering tests. Many testified that they had never met or spoken to him.
Additionally, Baldonado billed Medicare for office visits he never conducted. He never followed up with patients about their test results, and some never received them.
Bribes for Orthotic Braces
Baldonado also accepted illegal kickbacks from a medical equipment supplier in exchange for prescribing unnecessary orthotic braces. Undercover video evidence showed him receiving a large sum of cash for signing prescriptions.
Financial Impact
The fraudulent claims totaled more than $24 million. Medicare paid over $2.1 million to the laboratories and the medical equipment company involved in the scheme.
Conviction and Sentencing
A jury found Baldonado guilty of:
- Conspiracy to commit health care fraud (1 count)
- Health care fraud (6 counts)
- Soliciting and accepting illegal kickbacks (3 counts)
Following his conviction, authorities took him into custody. He faces up to 10 years in prison per fraud-related charge and up to 5 years per kickback charge. His sentencing is scheduled for June 26.
Investigation and Prosecution
The FBI Newark Field Office and HHS Office of Inspector General led the investigation. Assistant Chief Rebecca Yuan and Trial Attorney Hyungjoo Han from the Justice Department’s Fraud Section prosecuted the case.
For more updates on Medicare fraud, visit DOJ.gov.
New Update: New York Doctor Sentenced to Seven Years in $24 Million Medicare Fraud Scheme
The federal Medicare fraud prosecution involving New York physician Alexander Baldonado, M.D., reached a significant conclusion when he was sentenced to seven years in federal prison on October 23, 2025. The U.S. Department of Justice formally announced the sentencing on December 12, 2025, confirming that Baldonado was also ordered to pay $2,210,384 in restitution for his involvement in a Medicare fraud scheme involving medically unnecessary laboratory tests, fraudulent office visits, and orthotic braces.
The sentence followed a five-day federal jury trial in February 2025, during which prosecutors established that Baldonado participated in fraudulent activities that caused more than $24 million in claims to be submitted to Medicare. The jury convicted him on 10 federal criminal counts involving health care fraud, conspiracy, and illegal kickbacks.
Although the total fraudulent billing exceeded $24 million, Medicare actually paid more than $2.2 million based on the false claims. This distinction is important because the amount billed to a federal health insurance program does not necessarily represent the amount ultimately disbursed. The restitution order reflects the financial consequences established through the criminal proceedings.
Baldonado’s sentencing represents a substantial development from the original February 2025 report, which documented his conviction but described sentencing as an upcoming event. The confirmed prison sentence and restitution obligation establish the criminal penalties imposed for his participation in the fraudulent billing operation.
The Medicare fraud scheme centered on the exploitation of federally funded health care services during the COVID-19 pandemic. According to evidence presented at trial, Baldonado authorized hundreds of cancer genetic tests for Medicare beneficiaries who attended COVID-19 testing events at assisted living facilities, adult day care centers, and a retirement community in 2020. These events created opportunities for fraudulent billing because beneficiaries seeking legitimate COVID-19 testing were subjected to additional medical orders that were not supported by appropriate clinical evaluations.
Baldonado was not treating the patients who attended these events, and in numerous instances, he neither examined nor spoke with them before authorizing expensive genetic testing. Several beneficiaries testified that they did not know Baldonado and had never met him, despite records indicating that he had provided medical services. Prosecutors also demonstrated that he submitted Medicare claims for lengthy office visits that never occurred.
The fraudulent activity extended beyond laboratory testing to include unnecessary orthotic braces prescribed in exchange for illegal payments from a durable medical equipment supplier. Investigators obtained undercover video evidence showing Baldonado accepting cash in exchange for signed prescriptions. These activities resulted in payments to laboratories and medical equipment suppliers for services and products that lacked legitimate medical justification. The prosecution demonstrated how financial incentives and inadequate verification of medical necessity can contribute to coordinated Medicare fraud schemes involving physicians, laboratories, and equipment suppliers.
The sentencing also highlights the continuing importance of federal oversight of laboratory testing, durable medical equipment billing, and physician referral arrangements. The Department of Justice’s Criminal Division, the Federal Bureau of Investigation, and the Department of Health and Human Services Office of Inspector General investigated and prosecuted the case as part of broader efforts to identify fraudulent claims submitted to federal health care programs.
Federal anti-kickback laws generally prohibit knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce referrals or generate business reimbursable by federal health care programs. Health care providers are also required to ensure that services billed to Medicare are supported by appropriate medical documentation and comply with applicable coverage requirements. The Baldonado prosecution illustrates how violations can occur when physicians authorize testing without meaningful patient evaluations, accept improper financial incentives, or submit claims for services they never performed. Such conduct can expose federal health insurance programs to substantial financial losses while placing beneficiaries at risk of unnecessary procedures, misleading medical records, and disruptions in legitimate care.
The case further demonstrates that criminal accountability may involve imprisonment and restitution in addition to professional licensing or program participation consequences that could arise through separate administrative proceedings. As of October 2026, the verified case-specific development is Baldonado’s seven-year federal prison sentence and $2,210,384 restitution order. The official sentencing announcement does not establish a subsequent appellate outcome or any additional criminal sentence beyond those reported. The prosecution remains a significant example of federal enforcement against fraudulent Medicare billing and illegal financial arrangements involving medical professionals.
FAQs: Medicare Fraud Scheme
What was the Medicare fraud scheme involving Dr. Alexander Baldonado?
Dr. Baldonado was convicted of running a Medicare fraud scheme by billing for unnecessary cancer genetic tests and orthotic braces, many for patients he never treated.
How much money was involved in the Medicare fraud scheme?
The fraudulent claims totaled over $24 million, with Medicare paying more than $2.1 million to laboratories and equipment suppliers tied to the scheme.
What penalties does a Medicare fraud scheme conviction carry?
Convictions for a Medicare fraud scheme can result in up to 10 years in prison per fraud charge and up to 5 years per illegal kickback charge.
Who investigated the Medicare fraud scheme in New York?
The FBI Newark Field Office and the HHS Office of Inspector General led the investigation, working with the Justice Department’s Fraud Section.
Does Medicare have a fraud department?
Yes. Medicare fraud is primarily investigated by the HHS Office of Inspector General (OIG), which works alongside the FBI and other federal agencies. They identify, investigate, and prosecute Medicare fraud schemes like the $24 million case involving Dr. Baldonado.
Who is most responsible for Medicaid fraud?
Responsibility for Medicaid fraud typically lies with anyone who knowingly submits false claims, including healthcare providers, clinics, and sometimes patients. In large Medicare or Medicaid fraud schemes, the lead orchestrators—such as physicians or clinic operators—are held primarily accountable for organizing and profiting from fraudulent activities.
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