$10M in Medicare and Medicaid abused by Southern California-based clinics

Southern California-based clinics pay $10 million to resolve allegations that they abused the provisions of Medicare and Medicaid claims.

Mohammad Rasekhi M.D., Sheila Busheri, Southern California Medical Center (SCMC) and R & B Medical Group Inc., doing business as Universal Diagnostic Laboratories (UDL) are the parties involved.

The defendants have all been found complicit in a coordinated investigation by the Civil Division’s Commercial Litigation Branch, Fraud Section, U.S. Attorney’s Office for the Central District of California, and California Department of Justice.

The Department of Health and Human Services Office of the Inspector General helped the parties involved achieve this $10 million resolution.

“Providers who exploit the Medicare, Medicaid and TRICARE programs for their personal financial gain will be held accountable under the False Claims Act,” said U.S. Attorney Martin Estrada for the Central District of California. “This significant resolution evidences our steadfast commitment to ensuring the integrity of federally funded health care programs.”

Southern California clinics and owners hit with $10 million penalty

The Justice Department report stated that the group knowingly submitted false claims to Medicare and California’s Medicaid program, Medi-Cal. This was found as part of the coordinated investigation and had arisen from allegations that these false submissions fed an elaborate kickback and self-referral scheme.

The findings showed that the group knowingly paid kickbacks to marketers to refer Medicare and Medi-Cal beneficiaries to SCMC clinics in violation of the Anti-Kickback Statute (AKS).

They also knowingly paid kickbacks to third-party clinics in the form of “above-market rent payments, complimentary and discounted services to clinic staff, and write-offs of balances owed by patients and clinic staff” for referrals.

This investigation was fueled by Ferzad Abdi, Julia Butler, Jameese Smit, and Karla Solis, former employees or managers of SCMC and UDL (United States ex rel. Abdi v. Rasekhi, No. 18-cv-03966 (CDCA). Due to the findings, they will all receive $5 million in restitution, separate from the $10 million achieved in this court action.

“Kickback and self-referral schemes risk impairing the judgment of healthcare providers and diminish the reliability of the care that they render,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “This resolution upholds the department’s commitment to ensuring that Medicare and Medicaid beneficiaries receive care that is untainted by the providers’ financial interest.”

Image: Pexels.

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