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Response from Office of Stratford Doctor Accused of Fraudulent Billing

The following statement comes from the office of Dr. James P. Ralabate, who entered into a civil agreement Thursday after allegations surfaced that he and his company engaged in fraudulent billing at several nursing homes in Connecticut.

See related article: Stratford Doctor to Pay $700K for Alleged Nursing Home Scheme

Dr. Ralabate has an exemplary record of providing excellent care for all of his patients. He has never provided inappropriate or insufficient services. Because Dr. Ralabate always takes his patients' welfare as his primary concern, he believes he has greatly reduced his patients' suffering as well as hospital readmissions, saving money for his patients and the Government. Because of his excellent service, the skilled nursing facility's CMS rating under his care went from a 2 to a 5, which is the maximum rating such a facility can obtain.

Prior detailed audits by CMS proved that only 2 out of 54 procedures/services studied were coded higher than the documentation supported and only 1 was thought to be for more services than necessary, while 14 were actually under-coded. Even though he provided more services than his peers, 98.2 percent of the services studied extensively were found to be medically necessary. This prior audit actually resulted in increased payments to Dr. Ralabate.

Dr. Ralabate had an excellent administrative record. It was only when he later learned that the excellent level of care he provides to all his patients was found in a later audit to be beyond what Medicare pays for that he chose to settle the case -- rather than take time away from his patients and pay legal bills for a trial. This was a hard decision, because he learned during the Government's review that even investigators said they would love to have their parents receive the better than the customary care he provides.

The Government alleged that Dr. Ralabate billed for nursing home services while patients were in the hospital. Dr. Ralabate did in fact visit and provide his services to his nursing home patients in the hospital as part of his commitment to excellent and continuous care for his nursing home patients and he never billed for services that were not provided. The financial settlement was only based upon the Government's belief that some health services were miscoded, or provided more care than Medicare would pay for. He chose to hire billing and coding experts to prevent any risk of noncompliance and assure no future questions, and continue his exemplary care for his patients.

Joan Bershefsky February 01, 2013 at 12:13 AM
Myself and my family have been patients of Dr. Ralabate for over 25 years. He has given exemplary and compassionate service. Often times, it was above and beyond the call of duty. I have even been a patient of his while in a nursing home where he visited me and gave me excellent care. I have no doubt as to Dr. Ralabate's integrity and honesty. It is really a shame that such a good man and doctor who truly gives so much to his patients would be accused of any wrongdoing and that his excellent reputation would be in question. Having had many medical problems over the years and dealing with numerous physicians, we would all be much better off if there were more doctors like Dr. Ralabate. He not only gives excellent medical care, but also cares personally for every patient and their family. In our family he has been there from the birth of my grandchild to the death of my husband. He provided us with the physical and emotional support on every occasion. I am happy to have this opportunity to speak for him. Please do not judge him by what you read in the media. Sincerely, Joan Bershefsky
David Kennedy February 01, 2013 at 02:10 AM
Dr. Ralabate's statement rings 100% true and makes total sense. He has been our family's doctor for 28 years and his care was so good that when my mom turned ill and she needed to move from her home - far away from Stratford area - and into a nursing home, we moved my mom here and into a nursing home where Dr. Ralabate was the medical director. My family could not have asked for better care. And when she had episodic trips to the hospital as a short term patient, Dr. Ralabate was there. Equally telling is the way he has handled this whole thing. He made a mistake - that favored patients - and when it was brought to his attention, he admitted it and rectified it. No blaming, no whining, just professional. Thank you, Dr. Ralabate, for being who you are and for caring so wonderfully for our families. Hope you know how much you are appreciated by your patients and by your community.
Joan Bershefsky February 01, 2013 at 07:25 PM
This comment is directed to Jason Bagley who wrote this article. I feel that the title of your article is very inappropriate. By using the word "scheme", you lead people to believe that Dr. Ralabate planned to defraud Medicare. I believe that you owe him an apology. This is just another case of media sensationalism at the cost of someone's reputation. Please correct this. Thank you.
Joe Gagliardi February 02, 2013 at 12:13 AM
The Gagliardi Family, Dr Ralabate has been our family's doctor for over 30 terrific years. This article was horrible, as to lead people to believe that Dr Ralabate is a "scheme artist". He provides excellent care to each and everyone of his patients. Knowing him on a personal level as well as professional, he goes above and beyond for our entire family. Ralph and Agnes have had many health issues that have caused them to be in the hospital and Dr Ralabate took necessary measures to get them back on there feet each and every time. As for our children, and even grandchildren he has taken care of our entire family when they have needed him as well. We back him up 100%!!!!!! His entire staff is terrific not to mention his nurses......
Karen Murphy February 02, 2013 at 01:31 AM
I was at another Dr. and my daughter was not getting better, I was told she was fine...I brought her to Dr. Ralabate and she hasw pnamonia. My son was at 3 months old projectile throwing up...Dr. Ralabate said get him to Bpt. Hospital now and he met us there got us a specialist and he had piloricstirosis.... He has always been on the mark. I trust him 100%... I refuse to go to any other Dr. I have been with him for 27 years and I will not change. He cares for his patients and no matter what is said I trust Dr. Ralabate and support him 100%. Will I rec. him to thers....YES
Drew Ann Mingolello February 02, 2013 at 07:34 AM
My husband and I find it incomprehensible to think that at some point of his medical career, Dr. Ralabate, this good hearted and honest doctor, would even try to do the unthinkable; scheme, commit Medicare fraud, then try to get away with it. Whatever happened is not a deal breaker for keeping Dr. Ralabate as our family doctor and friend. We believe in him as much now as we did last Thursday and wish him the very best.
PCRN February 02, 2013 at 05:18 PM
I HAVE KNOWN THIS FINE DOCTOR AT WORK. AS A MEMBER OF THE STAFF AT LOCAL NURSING HOME HE IS THE BEST AND THE TOTAL PROFESSIONAL AT HIS JOB.THE NURSING HOME WOULD NOT BE THE SAME AND THOUGHT OF AS ONE OF THE BEST WITHOUT HIM BEING A ASTAFF MD THERE.TO DISCREDIT HIM WITH THESE HEADLINES DOES HIM A REAL INJUSTICE,HE WAS AT THE HOME EVERY EVENING MANY TIMES, SAW PTS OF HIS WHEN ASKED TO AND IS KIND AND PROFESSIONAL TO PTS FAMILIES AND STAFF.YOU WERE WRONG TO WRITE SCHEME, SHAME ON YOU!!!!!!!!!!!!!!.WHAT EVER YOU WRITE IT WILL NOT TAKE AWAY FROM THIS MANS REPUTATION AS A PERSON OR A CARING MD. FROM A NURSE OF 40 YRS THAT WORKED WITH HIM.
Gana ber February 02, 2013 at 09:13 PM
I met this doctor at work, i work in a nursing home. He is very caring and compassionate. He never hesitates to help and his patients love him. He is a great doctor.
bpiretti February 02, 2013 at 09:28 PM
I agree with everyone who has written. My whole family has been going to Dr. Ralabate for 25 years. I would trust Dr. Ralabate with our lives. He has always been there for us and has always been totally professional and friendly. I know that he cares very much for his patients. My family will not be going anywhere else! He also has a very professional and friendly staff. The Herde Family
Amanda February 03, 2013 at 01:06 AM
Dr. Ralabate has been my doctor for the 27 years I have been alive. Through those years I have faced many medical obstacles. Who is the one person that I could count on to show up at the hospital after every surgery? Who is the one person who woke up in the middle of the night to answer my parent's panicked phone call from a cruise ship in the Bahamas when I had my first seizure? Who was the one who helped me retrain my body to walk after a life saving surgery, showing up each day to help me move a couple feet further? DR RALABATE. If anyone can be labeled a hero, an angel, it is him. To see his name in the same line as the word "scheme" is such a shame. I am saddened that the press finds it appropriate to run someone's name through the mud or tarnish their reputation with one news headline. Do you really know the man you are targeting? It is so refreshing to read the above posts. It seems as if Dr. RALABATE is a hero to many. That is what the world needs to know. His name needs to be in the headlines with the words COMPASSION. KINDNESS. EXTRA MILE. LOVE. SUPPORT. and so much more! With out Dr. RALABATE's care I don't know where I would be today. To him I could only say THANK YOU & you have our support. Amanda
msonherown February 04, 2013 at 04:32 PM
I too am outraged by the title of this article as well as the ludicrous accusations made by Fein who states he is "committed to tracking down doctors and other health care providers who submit fraudulent claims to federal health care programs". Really? Most likely you're committed to making a name for yourself and needed to make an example of someone. Obviously you don't know anything about Dr. Ralabate or you may have chosen someone else for your "scheme". From what I've read in the article it seems the only thing Dr. Ralabate's office is guilty of is needing to improve their documentation system. Perhaps because he has chosen to devote his time to giving his patients the highest level of care rather than worrying about reporting to big brother....
Patti Saad February 04, 2013 at 06:20 PM
Dr. Ralabate (fondly Dr. Jim to us) has been our family doctor for over 28 years. We are heartsick by the article in the Stratford Patch and how it depicted Dr. Ralabate. To put his name next to the word "scheme" or talk about anything fraudulent is beyond comprehension if you know the man you are writing about. You have no knowledge of who this doctor is and how he is dearly loved by so many. But that aside, you have not a clue what a good, decent and kind human being you are talking about. He is dedicated and trustworthy. To know Dr. Ralabate is to know someone who is the "ultimate" doctor. He treats his patients with the utmost care and concern and goes above and beyond what most doctors will do. He treats each of his patients as if he were treating one of his own family members. Dr. Ralabate is the doctor to go to when you need answers. He is brilliant at getting to the root of the problem. We have a daughter with autism. He has spent countless hours with us over the years, advising and steering us toward the right doctors and the right decisions for her well-being and future. Our oldest daughter was very sick a few years back and Dr. Ralabate worked dilligently with her other doctors to help her get better. He visited her every day when she was in the hospital. He is truly one of the most decent, honest and caring persons we have ever known. You owe him an apology for your portrayal of him. The Saad Family
Jason Bagley (Editor) February 04, 2013 at 06:46 PM
Readers, In no way was I out to slander Dr. Ralabate's name with the headline "Stratford Doctor to Pay $700K for Alleged Nursing Home Scheme." That headline reflects the allegations brought forth by the government. I quote from a statement released by U.S. Attorney David B. Fein: "The government further alleges that Ralabate billed Medicare for services he supposedly provided to patients in nursing homes when the patients were, in fact, not present in the nursing homes. Instead, the patients had been transferred to local hospitals for treatment. Yet Ralabate billed government health care programs as if he had provided medical services in the nursing homes."
MJLSr February 04, 2013 at 10:00 PM
Did you look into these allegations? No doubt, as mentioned in some of the posts, the Doctor was following his patients when they were moved to the hospital. And the word "scheme" is your headline and you should take responsibility for using such an inflammatory term to simply get attention. Dr Ralabate is as good a doctor and person as all of these posts indicate. If this kind of persecution of caring medical professionals is what we're in for as we move closer and closer to socialized medicine then this country is in serious trouble.
Marie hudak February 04, 2013 at 10:24 PM
Marie Hudak RN I have worked with Dr. Ralabate in several skilled nursing facilities and he is a physician that you would want for yourself and your family. He is professional, has excellent bedside manners, which is a dying asset with physicians, but more importantly, he's genuinely concerned for his patients and cares enough to follow through with diagnosing accurately and ensure proper care. He is the real deal.
Drew Ann Mingolello February 04, 2013 at 10:57 PM
Dear Mr. Jason Bagely, You said in your article 'In no way was I out to slander Dr. Ralabate's name', but you did. Jack and Drew Mingolello
Baffled Resident February 04, 2013 at 11:39 PM
While i quite honestly don't have a very high opinion of the editor in question.............. I'm not sure i agree with everyone's criticism of his article. Maybe you love this guy Ralabate, but the fact is, he repaid the government $700,000. That $700,000 in fraudulent billing occurred over a period of 5.5 years. $128,000 a year in fraudulent billing. Why didn't the "honest" doctor take it to court? $700,000 isn't chump change. Then again, perhaps it is chump change for Ralabate. I mean hell, if he can give back $128,000 of his annual take for those 5.5 years, how the heck much was he pulling in?
Hayley Vyas February 05, 2013 at 12:15 AM
Dr. Ralabate has been my doctor for 28 years now. A few years ago, I got very sick and it was Dr. Ralabate who thoroughly investigated and helped in treating this very complicated issue that many other doctors didn’t seem to understand and even misdiagnosed. He was the doctor that was able to get to the root of this complex issue that was going on and he came up to the hospital almost every day to check in with me, as well as collaborating with many other specialists to make sure I had the best care possible. Dr. Ralabate genuinely cares for each and every one of his patients and has always gone above and beyond the necessary care that is required. He is a kind, compassionate, and honest person and I am truly appalled that a “catchy” news title/article is what’s more important to the media than this good man’s reputation. Based on my experiences with Dr. Ralabate, (along with all of these wonderful comments from patients, friends and medical staff ) it is crystal clear what an exemplary, kindhearted and honest person Dr Ralabate is-- and just how very wrong this article is.
Patti Saad February 05, 2013 at 02:27 AM
To baffled resident, In Dr. Ralabate's response to these charges it is stated why he chose to settle this case by paying 700,000 instead of entering into a long, costly trial which would interfere with his practice of genuinely caring for his patients. This makes total sense. You sound very cynical and angry. You do not know Dr. Ralabate. If you did, your response would have a totally different tone to it.
Baffled Resident February 05, 2013 at 02:43 AM
Why would it have a different tone? Just because he's a nice guy? Come on, a thief is a thief. Whether or not he's caring and compassionate is irrelevant. Medicare is paid for by us, the taxpayers. If he wasn't defrauding Medicare, there's no excuse for not taking it to trial. Innocent people don't just hand over SEVEN HUNDRED THOUSAND DOLLARS!
Mike Leone February 05, 2013 at 02:20 PM
All too often in business we are faced with settling disputes because it is less costly in terms of dollars, emotional stress, and intellectual capital. Legal fees alone for the doctor in a case like this have to be an enormous burden. It's not easy to fight this federal government. One of the risks in taking such a course of action is that the ignorant and uninformed in society read guilt into the situation when none is admitted or present. Anonymous posts by cowards are simply best ignored.
Yanks5881 February 05, 2013 at 02:33 PM
Having worked in the medical field for over 20 years, physicians are extremely educated in clinical coding for all matters. They are fully aware of what codes need to be justified by what means. Specifically, I am sure Dr. Ralabate was fully aware of how he coded his visits. Each code carries specific guidelines and each have to be met in order to charge that particular dollar amount. He may be a wonderful person, doctor, friend, but unfortunately he has been caught overbilling for his services. This is a long process, audits take years to complete. I doubt, with all the evidence Medicare had against him, that a trial would have been successful for him. You don't settle for an amount of $700,000 if you are NOT GUILTY. Any person with such ethics, I am sure, would not just settle but instead fight the battle to prove his innocence.
Joan Bershefsky February 06, 2013 at 03:18 PM
How quick people are to judge. Unless you have walked in this man's shoes,then you have no right to say that he is guilty. This whole situation has been a witch hunt because a doctor gave extra care to his patients. He had every right to be compensated. Those of you who make cynical and negative assertions might want to know the person involved before you make such cruel comments. Judge not lest ye be judged. What a waste of our tax dollars to spend so much time investigating a good decent man. Let he who is without sin cast the first stone.
pebcrn February 08, 2013 at 12:37 AM
PCRN. I AGREE THAT THIS IS A SLANDERIOUS AND A WITCHHUNT OF A EXCELLANT MD AND A GOOD, KIND AND TOTALLY PROFESSIONAL PERSON.YES IT WAS A BILLING CODE ISSUE AND IT WAS FOUND, BUT THE MAN RECTIFIED THIS ISSUE AND WILL IN THE FUTURE HAVE HIS CODE PROFESSIONALS OVERSEE THIS PART OF HIS BILLING,BUT TRUST ME WHEN I SAY THIS .YOU CAN NOT PAY ENOUGH FOR WHAT THIS MAN GIVES IN HIS CARE .THE GOVT SHOULD PAY HIM DOUBLE.I'VE KNOWN THIS MD FOR MANY YEARS IN THE NURSING HOME FIELD AND IT WAS NOT INTENTIONAL WHAT HAPPENED. WHY SHOULD HE WASTE THE TIME FOR A TRIAL, HIS PTS ,FAMILY AND THE COMMUNITY NEED HIM.MR FEIN SHOULD GO AFTER THE A FEW OTHER MDS ON STAFF WHO TELL THE STAFF AT THE NURSING HOMES THEY ONLY MAKE 18 DOLLARS A VISIT AND 150 FOR AN ADMISSION TO THE NURSING HOME.THEY COME IN ONCE AND THEN ALMOST FORGET THE PT IS THERE.THIS IS A FACT AS I HAVE WORKED IN A LOCAL FACILITY FOR OVER 25 YEARS.THE APRNS AND NURSES DO ALL THE WORK FOR THESE OTHER MDS.DR RALABATE HAS NEVER SAID THAT AND GOES ABOVE AND BEYOND IN HIS CARE AND INTEREST FOR HIS PTS.YOU DO ,MR BAGLEY OWE HIM AN APOLOGY AS WELL AS MR FEIN AND THE GOVT.
Melissa Whitaker March 12, 2013 at 10:50 PM
Dr. Ralabate has always been a caring, compassionate doctor. I'm proud to say that I worked for him for a short time. He always took time with his patients, LISTENED to them (that is huge!) and was and is 100% professional. When my husband was a patient at a local ECF, Dr. Ralabate visited him, went over his meds, answered any questions and concerns that my husband had and took excellent care of him. I do not believe the allegations against him. He is an excellent doctor , a God-fearing man, and one one the best family men I know. May God bless you, Doc!

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