“A stitch in time may save nine” but a New Jersey pediatrician is facing a lengthy prison sentence after billing Medicare for thousands of stitches and other wound repairs never performed. While pediatricians often stitch up kids who get cut up and suffer minor scrapes, the feds say Dr. Badawy M. Badawy didn’t actually perform any of the surgeries or procedures. The Justice Department says Badawy was running a massive Medicare fraud scheme from his office in Bayonne, New Jersey.
Medicare uses precise billing codes to define the level of service performed by a healthcare provider. Doctors are paid according to the type service performed. Three of those codes refer to stapling or suturing wounds in a doctor’s office. (Most patients go to an emergency room or urgent care.) According to an FBI affidavit, Dr. Badawy submitted so many claims to Medicare that his billings represented somewhere between 67% and 99% of all New Jersey wound care claims from a physician’s office!
Badawy was paid approximately $900,000 for these services. The problem for Dr. Badawy is that the FBI says in the vast majority of cases no such service was performed.
In once case, the FBI says that Badawy’s Medicare records show 49 wound repairs performed on 3 siblings during 28 office visits. The mother of the three kids, however, said her children never had any wounds needing closing or stitches.
After a lengthy FBI investigation, Badawy was charged with Medicare fraud. He pleaded guilty earlier this year and is awaiting sentencing. He faces 10 years in prison when sentenced next month.
Prior to pleading guilty, Badawy apparently attempted to hinder the government’s investigation. He claimed that smoke and water damage from a fire destroyed his records. A subsequent search by law enforcement found many of the “missing” records and found no smoke or water damage or evidence of fire.
Medicare fraud has reached epidemic proportions. Congress has authorized prosecutors to pay whistleblowers awards for coming forward with information about Medicaid and Medicare fraud. The federal False Claims Act pays whistleblowers up to 30% of whatever the government collects.
To qualify for an award, one must have original source information about a fraud involving a federal program or tax dollars. Simply picking up the telephone and calling a regulators or a Medicare fraud hotline doesn’t get you the award, however. Whistleblowers must first file a sealed lawsuit in federal court.
Think you may qualify as a whistleblower? Give us a call. Our clients have received over $100,000,000.00 in award monies. For more information, contact attorney Brian Mahany at or by telephone at (414) 223-0464.
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