LAX Leader

Mohammad Rasekhi M.D., Sheila Busheri, Southern California Medical Center (SCMC), and R & B Medical Group Inc., operating as Universal Diagnostic Laboratories (UDL), have agreed to a $10 million settlement. The resolution addresses allegations of submitting false claims to Medicare and Medi-Cal due to kickbacks and self-referrals. All parties involved are based in Southern California.

The United States alleged that the defendants submitted false claims by paying kickbacks to marketers for referrals of Medicare and Medi-Cal beneficiaries to SCMC clinics, violating the Anti-Kickback Statute (AKS). They were also accused of providing kickbacks to third-party clinics through above-market rent payments, complimentary services, and write-offs in exchange for patient referrals to UDL for laboratory tests. Additionally, they allegedly referred patients from SCMC clinics to UDL in violation of the Stark Act's prohibition against self-referrals.

The AKS prohibits offering or paying remuneration for referring individuals under federal health care programs. Similarly, the Stark Act prevents physicians from referring patients for designated health services payable by Medicare or Medicaid if there is a financial relationship unless an exception applies.

“Kickback and self-referral schemes risk impairing the judgment of healthcare providers and diminish the reliability of the care that they render,” stated Principal Deputy Assistant Attorney General Brian M. Boynton. He emphasized the department's commitment to ensuring untainted care for Medicare and Medicaid beneficiaries.

U.S. Attorney Martin Estrada expressed that “providers who exploit the Medicare, Medicaid and TRICARE programs for their personal financial gain will be held accountable under the False Claims Act.” Acting Special Agent Eric Larson added that this settlement reminds providers receiving program funds must operate with integrity.

Special Agent Bryan D. Denny noted that “the announced settlement brings closure to the defendants’ schemes” affecting federal healthcare programs like TRICARE. The State of California will receive approximately $4 million from this settlement as part of its contribution towards Medicaid claims at issue.

The case partially resolves claims brought under qui tam provisions by former employees or managers Ferzad Abdi, Julia Butler, Jameese Smit, and Karla Solis. Their separate $5 million settlement with defendants addresses additional allegations not pursued by federal or state authorities.

This resolution resulted from coordinated efforts among various government entities emphasizing combating healthcare fraud using tools like the False Claims Act. Tips about potential fraud can be reported at 800-HHS-TIPS (800-447-8477).

Trial Attorney Samson Asiyanbi and Assistant U.S. Attorney Jack Ross managed this matter on behalf of their respective offices.

It is important to note that these resolved claims are only allegations without any determination of liability.