California Skilled Nursing Facilities, Owner and Management Company Agree to $45.6 Million Consent Judgement to Settle Allegations of Kickbacks to Referring Physicians
Doctor Shoaib Qureshi, Doctor Imran Mirza, Memphis Primary Care Specialists, Lunceford Family Health Center, and Getwell Family Medicine agreed to pay $341,690 to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for services rendered by nurse practitioners at the higher reimbursement rate for physician services, the Justice Department announced today.
Doctor Qureshi and Doctor Mirza are family medicine physicians who practice in and around Memphis, Tennessee. Doctor Qureshi owns and operates Memphis Primary Care Specialists and Lunceford Family Health Center; Doctor Mirza owns and operates Getwell Family Medicine.
“Healthcare providers who overcharge Medicare contribute to the soaring cost of health care,” said Acting Assistant Attorney General Jeffrey Bossert Clark for the Department of Justice’s Civil Division. “The department will continue to investigate and hold accountable those who seek to enrich themselves at the expense of federal health care programs and the American taxpayers.”
"Falsely billing Medicare for services by absent physicians encourages fraud, waste, and abuse of taxpayer funds and can ultimately harm patients," said D. Michael Dunavant, U.S. Attorney for the Western District of Tennessee. "Settlements like this achieve provider accountability, protect public funds, and safeguard the beneficiaries of federal health care programs."
“Medicare is a system based on trust and depends on the integrity of health care providers,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Physicians have a duty to ensure claims are accurate in order to prevent the program from over-paying for the services rendered to patients.”
Medicare pays a higher rate for physician services than for non-physician services. Medicare will pay the higher physician rate for services rendered by non-physician providers if the services are “incident to” the services of a physician. Such “incident to” services, however, must be provided under the direct supervision of a physician. The United States alleged that, from 2015 to 2018, Doctor Qureshi, Doctor Mirza, and their clinics billed Medicare as though the physicians had provided the services in question, when in fact nurse practitioners had treated the patients without the supervision required by Medicare’s “incident to” rules. Indeed, the government alleged that the services were rendered when the physicians were out of the office, including times when they were traveling out of state or abroad.
The settlement resolves allegations filed in a lawsuit by Michael Grace under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in any recovery. The civil lawsuit is docketed in the Western District of Tennessee and is captioned United States; the States of California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Tennessee, and Texas; the Commonwealths of Massachusetts and Virginia; and the City of Chicago ex rel. Grace v. Tenet HealthCare Corp., St. Francis Hospital-Memphis, Desert Regional Medical Center, Apollo MD, Shoaib Qureshi, MD; and Imran Mirza, MD, Case No. 2:20-CV-2209. As part of this settlement, Grace will receive $58,087 as his share of the government’s recovery.
The resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
This matter was investigated by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Western District of Tennessee, and the Office of Inspector General for the U.S. Department of Health and Human Services.
The claims resolved by this settlement are allegations only and there has been no determination of liability.