Sep. 25, 2023 By Bill Parry
A Flushing-based pulmonologist will have to pay $1.3 million in restitution as part of a settlement agreement with the U.S. Justice Department after he over-billed nursing home residents for years, U.S. Attorney Breon Peace announced last week.
The deal addresses allegations that Dr. Arun Arora violated the federal False Claims Act by billing Medicare for critical care services to residents of nursing homes in Queens when he provided only routine care, such as regular medical checkups.
Critical care services involve imminent life-threatening deterioration of a patient’s condition and Medicare reimburses health care providers at a higher rate for critical care services than for routine care, according to federal prosecutors. By billing for critical care services when he provided only routine care, as the government contends, Dr. Arora received extra payment for care that he did not provide.
Under the terms of the agreement with the U.S., Dr. Arora will pay the $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 claim, Dr. Arorahas entered into a separate “integrity agreement” with the U.S. Department of Health and Human Services, Office of Inspector General, which imposes a number of obligations meant to ensure 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,” U.S. Attorney Breon Peace said. “When health care providers over-bill the program, Medicare cannot ensure that services are going to the people who need them most.”
He added that the claims resolved by the settlement are allegations only and there has been no admission of or determination of liability.