WNY Medical Agrees to $251K Settlement Over Alleged False Medicare Claims

According to federal prosecutors, the health care provider, which operates in Erie and Niagara counties, improperly billed Medicare for Chronic Care Management services between January 2020 and March

Western New York Medical P.C. has agreed to pay $251,477 to settle allegations that it submitted false claims to federal health care programs, the U.S. Attorney’s Office for the Western District of New York announced.

According to federal prosecutors, the health care provider, which operates in Erie and Niagara counties, improperly billed Medicare for Chronic Care Management services between January 2020 and March 2023. The government alleges that WNY Medical submitted claims for encounters that required at least 20 minutes of clinical staff time per month but failed to meet that threshold in some cases.

Acting U.S. Attorney Joel L. Violanti emphasized the importance of financial accuracy in federal health programs. “The financial integrity of the Medicare program depends on providers accurately and truthfully reporting the services that they are providing,” he said. “This office is committed to protecting the integrity of the Medicare program by holding providers accountable when they seek payments for which they are not entitled.”

The settlement resulted from a joint investigation by the U.S. Attorney’s Office and the U.S. Department of Health and Human Services Office of Inspector General. Officials noted that the claims resolved by the settlement are allegations, and there has been no determination of liability.