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LOS ANGELES (CNS) - A former Van Nuys doctor and other defendants have agreed to pay $15 million to settle allegations of submitting false claims to federal health care programs by paying illegal kickbacks and abusing patient referrals, officials announced Thursday.
Mohammad Rasekhi, who surrendered his medical license earlier this month, along with Sheila Busheri, Southern California Medical Center, and R & B Medical Group Inc., also known as Universal Diagnostic Laboratories, agreed to the settlement, according to the U.S. Department of Justice.
Prosecutors said Rasekhi is the founder and chief medical officer of SCMC and the co-owner of UDL. Busheri is the chief executive officer of SCMC and the co-owner and chief executive officer of UDL. SCMC is a federally qualified health center that operates six clinics in Southern California. UDL is a reference and esoteric laboratory in Southern California.
Medicaid is funded jointly by the states and the federal government. The state of California paid a portion of the Medicaid claims at issue and will receive about $7 million from the settlement, court papers show.
The government alleged that the defendants knowingly submitted or caused the submission of false claims to Medicare and Medi-Cal by:
-- paying kickbacks to marketers to refer Medicare and Medi-Cal beneficiaries to SCMC clinics in violation of the Anti-Kickback Statute;
-- paying 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 in exchange for referring Medicare and Medi-Cal beneficiaries to UDL for laboratory tests in violation of the AKS; and
-- referring Medicare and Medi-Cal beneficiaries from SCMC clinics to UDL for laboratory tests in violation of the Stark Act's prohibition against self-referrals.
The federal anti-kickback law prohibits those who participate in federal health care programs from offering or paying remuneration in return for referring someone to, or arranging for services, by a federal health care program.
Likewise, the Stark Act, also known as the Physician Self-Referral Law, prohibits doctors from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
"There is an expectation that providers who receive Medicare and Medicaid program funds obey the law and operate with integrity," Eric Larson, acting special agent in charge of the U.S. Department of Health & Human Services Office of the Inspector General, said in a statement.
"This settlement is a reminder that HHS-OIG is committed to working with our law enforcement partners on holding those providers accountable who exploit taxpayer-funded healthcare programs for their own personal gain."
The settlement resolves claims brought under the "whistleblower" provisions of the False Claims Act in a joint filing by Ferzad Abdi, Julia Butler, Jameese Smith, and Karla Solis, who were former employees or managers of SCMC and UDL, according to the DOJ.
The settlement includes a $10 million payment for the portion of the case handled by the United States and a $5 million payment in a separate settlement between the relators and the defendants, papers filed in Los Angeles federal court show.