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DOJ intervenes in $50 Million Healthcare Fraud Case

Posted  March 2, 2017

By the C|C Whistleblower Lawyer Team

Preet Bharara, US Attorney for the Southern District of New York, announced a civil suit and criminal actions against several doctors and health care entities alleging over $50M in fraud through schemes that lasted over 12 years. Five of the six doctors charged in their personal capacity were arrested in the New York area on Wednesday.

The allegations center around Asim Hameedi, a cardiologist and owner of City Medical Associates (CMA), who allegedly conducted a twelve year scheme to defraud Medicare, Medicaid, and private insurers. Most of the other doctors named in the allegations were CMA employees. Another doctor, Emad Soliman, who owns a Neurology practice in Westchester, New York, was charged with knowingly participating in the scheme by allowing CMA to submit false claims to insurance providers in his name.

Specific allegations against CMA and the doctors include:

  • Exaggerating the severity of patient medical conditions to obtain preauthorization for certain medical tests and procedures
  • Submitting false claims to Medicare and Medicaid for services that were not performed or were medically unnecessary
  • Submitting false claims listing doctors who did not work at CMA as the listed provider
  • Paying kickbacks in exchange for lucrative referrals
  • HIPAA violations

In all, the six doctors face 10 distinct criminal counts, as well as a civil law suit. The criminal counts have the potential to result in 87 years in prison.

The government’s civil complaint joins a False Claims Act lawsuit previously filed under seal by a whistleblower.

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Private Insurance Whistleblower Reward Programs, Provider Fraud,