The U.S. Department of Justice has recently announced a hefty settlement involving Southern California health care providers accused of fraudulent activities. According to the U.S. Attorney's Office, Central District of California, a conglomerate of health entities, led by former physician Mohammad Rasekhi, has agreed to pay $15 million to resolve allegations of submitting false claims through illicit practices, including kickbacks and self-referrals.
Surrendering his medical license earlier this month, Rasekhi was instrumental at the helm of Southern California Medical Center (SCMC) and its sister laboratory, Universal Diagnostic Laboratories (UDL). With him, Sheila Busheri, who served as both CEO of SCMC and UDL, also faced allegations in the scheme that, according to authorities, ran afoul of federal healthcare program guidelines, as reported by the U.S. Attorney's Office, Central District of California. In a complicated scheme that repaid marketers to draw in Medicare and Medi-Cal beneficiaries to SCMC's six clinics, these practices led to the settlement at the core of today's announcement.
"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, as stated by the U.S. Attorney's Office, Central District of California. Brian M. Boynton, Principal Deputy Assistant Attorney General, echoed Estrada's sentiment stating, "Kickback and self-referral schemes risk impairing the judgment of healthcare providers and diminish the reliability of the care that they render." This resolution seeks to uphold the sanctity of care provided to Medicare and Medicaid beneficiaries, free from the corrupt influence of financially motivated referrals.
The settlement also addresses whistleblower claims originally filed under the False Claims Act's qui tam provisions. This mechanism allows private parties, in this case, former employees and managers of SCMC and UDL, to sue on behalf of the United States. Successful claimants in such cases stand to receive a portion of any recovered funds as a reward for their role in uncovering fraud. The whistleblowers' vigilance reflects the government's determined approach to rooting out health care fraud, with the Justice Department, the U.S. Attorney’s Office for the Central District of California, and the California Department of Justice coordinating the multi-agency effort, as well as receiving support from HHS-OIG and DCIS.
