A New York doctor has been sentenced in federal court in Boston for receiving kickbacks in exchange for ordering medically unnecessary brain scans.
The defendant, 76, was sentenced on Dec. 9, 2025, to two years of supervised release, one year of which will be served in home confinement with location monitoring. He was also ordered to pay a $50,000 fine, $48,000 in forfeiture, and $342,876 in restitution. In November 2024, he pleaded guilty to one count of conspiracy to commit healthcare fraud.
The defendant, an internist from Long Island, NY, was a licensed medical doctor in New York for approximately 47 years. From approximately June 2013 through December 2019, he conspired with others, including a principal of a mobile medical diagnostics company that performed transcranial doppler (TCD) scans, to order hundreds of medically unnecessary TCD scans in exchange for kickbacks. TCD scans measure blood flow in parts of the brain.
According to court records, the defendant and his co-conspirators used false diagnoses to order the unnecessary scans. A co-conspirator then submitted claims to Medicare and other insurers, including private insurance companies, on behalf of the diagnostic company. In exchange, the defendant received cash kickbacks of approximately $100 per test. The scheme resulted in fraudulent billings of approximately $891,978 to Medicare and private insurers.
Compliance Perspective
Issue
Medical services billed to Medicare, Medicaid, or private insurers must be medically necessary and supported by appropriate clinical documentation. A service is considered medically necessary when it is essential for diagnosing or treating an illness, injury, condition, disease, or its symptoms. Submitting claims for unnecessary services may violate the False Claims Act and could result in significant penalties, including fines, criminal charges, and other sanctions. Under federal and state Anti-Kickback Statutes, it is illegal to offer, pay, solicit, or receive anything of value to induce or reward referrals involving federal or state healthcare programs. This prohibition applies equally to those offering kickbacks and those receiving them. Kickbacks can take various forms—such as cash, bribes, rebates, or other benefits. Failing to promptly report known or suspected kickbacks may lead to serious legal consequences, including lawsuits, fines, and additional sanctions.
Discussion Points
- Review and, if necessary, revise policies and procedures related to medical testing services, referral practices, and billing to ensure they clearly address medical necessity requirements and prohibitions under the Anti-Kickback Statute. Facilities may benefit from working with an external consultant to review current practices, identify risk areas, and strengthen safeguards designed to prevent improper referrals or billing.
- Provide training to staff responsible for determining medical necessity, ensuring they understand how to assess whether services are reasonable and supported by documentation. Train all staff on recognizing potential kickbacks and understanding their obligations under the Anti-Kickback Statute, including mandatory reporting protocols for suspected violations. Med-Net Academy offers Fraud Series Module 9 – Independent Contracts and Referrals, which teaches staff how to follow company contracting policies, understand referral requirements, and recognize key elements of the Anti-Kickback Statute.
- Conduct periodic audits to assess compliance with medical necessity standards and anti-kickback requirements. Audits should evaluate ordering patterns, documentation, and staff awareness of reporting obligations. Facilities may consider engaging an external consultant to perform targeted reviews or mock audits to identify compliance gaps early and support corrective action before regulatory or enforcement issues occur.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*