By Forum Staff
Brooklyn U.S. Attorney Breon Peace announced on Thursday a settlement agreement with Flushing-based physician Arun Arora. The settlement agreement addresses allegations that Arora violated the federal False Claims Act by billing Medicare for critical care services to residents of nursing homes when, in fact, he provided only routine care.
Arora provided care to residents of nursing homes. That care was, for the most part, routine care, such as regular medical checkups. The government contends that, rather than billing for his services as routine care, Arora billed Medicare for critical care services. Critical care services involve imminent life-threatening deterioration of the patient’s condition. Medicare reimburses health care providers at a higher rate for critical care services than for routine care. By billing for critical care services when he provided only routine care, as the government contends, Arora received extra payment for care that he did not provide.
Photo Courtesy of the U.S. Attorney’s Office for the Eastern District of NY
“When health care providers overbill the program, Medicare cannot ensure that services are going to the people who need them most,” Brooklyn U.S. Attorney Peace said.
Under the terms of the agreement with the federal government, Arora will pay $1.3 million for conduct that took place in the years 2019 to 2023. In addition to the payment to resolve the government’s fraud claims, Arora has entered into a separate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. The Integrity Agreement imposes a number of obligations on Arora, all of which are meant to ensure that he complies with Medicare rules and regulations going forward.
“Our Medicare program, which provides health care services to the elderly, works only if its funds are expended properly,” Peace said. “When health care providers overbill the program, Medicare cannot ensure that services are going to the people who need them most.”
The claims resolved by the settlement are allegations only and there has been no admission of or determination of liability, Peace added.
