Medical center owners allegedly double billed insurers, altered patient records as part of $80M scheme

Four people have been charged in an $80 million Medicare fraud scheme that involved providing unnecessary medical treatment to patients, according to the Mid Hudson Valley Patch.

According to an indictment unsealed Aug. 30, James Spina, Jeffrey Spina, Kimberly Spina and Andrea Grossman participated in a healthcare fraud scheme through their fraudulent operation of Dolson Avenue Medical in Middletown, N.Y.

James and Jeffrey Spina, who are brothers, allegedly ran the daily operations of the medical clinic, including billing insurers. They concealed their ownership and control of the clinic by recruiting other physicians to serve as the nominee owners, according to the indictment.

The Spina brothers, with the help of Ms. Grossman and Ms. Spina, submitted fraudulent claims to insurers for services that were not rendered or were not medically necessary, and double billed two different insurance companies for services, according to the indictment. They also allegedly altered and fabricated medical records and impeded audits by government and commercial payers.

The four people named in the indictment were charged with one count of conspiring to commit healthcare fraud and one count of healthcare fraud. The Spina brothers were also charged with one count of obstructing and impeding a federal audit.

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