Physician pays $1.8M to settle False Claims Act liability

HOUSTON – A Houston-area doctor and his diagnostic facilities have agreed to pay to resolve False Claims Act (FCA) allegations regarding the submission of claims to Medicare and Medicaid that were medically unnecessary and in violation of the Physician Self-Referral Law (aka Stark Law), announced U.S. Attorney Alamdar S. Hamdani.

From July 22, 2014, through July 10, 2017, Dr. Mohammad Athari, 80, Houston, and United Neurology P.A. allegedly engaged in a pattern and practice of falsely billing Medicare Part B. The claims were for services that were not reasonable or medically necessary because the patients’ diagnoses or medical records did not support them or unlicensed and untrained technicians had incorrectly or inadequately rendered them.

This settlement also resolves allegations that from Jan. 7, 2014, through Jan. 8, 2021, Athari submitted or caused the submission of false claims to Medicare by billing for diagnostic imaging procedures in violation of the Stark Law. Athari allegedly referred his neurology patients to diagnostic centers he owns (Universal MRI Baytown, Universal MRI Humble and Universal MRI Conroe) in violation of the Stark Law.

The Stark Law seeks to safeguard the integrity of the Medicare program by prohibiting physicians from referring patients to receive “designated health services” Medicare pays from entities with which the physician has a financial relationship.

“The Stark Law was enacted to ensure that a physician’s clinical judgment is not corrupted by improper financial incentives,” said Hamdani. “Similarly, physicians that bill government healthcare programs must ensure they are billing for medically necessary services and not just maximizing their own income. Our office will continue to pursue cases that will protect the integrity of government healthcare programs and safeguard taxpayer dollars while ensuring that patients receive consistent and quality care.”

“Personal financial incentives corrupt the medical decision-making process, leading to harm for patients and depletion of funds from federally funded health care programs. Physicians who fraudulently submit medically unnecessary claims prioritize profit over their duty to patients,” said Special Agent in Charge Jason E. Meadows with the Department of Health and Human Services - Office of Inspector General (DHHS-OIG). “DHHS-OIG remains steadfast in holding accountable those who prioritize personal gain over delivering legitimate medical services.”

The settlement stems from a qui tam or whistleblower complaint filed under the FCA which permits a private party to file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is United States ex rel. Lisa Parker v. Mohammad Athari M.D., et al. (4:20-cv-02056). The whistleblowers will receive 18% of the proceeds from the settlement with Athari.

The U.S. Attorney’s Office for the Southern District of Texas and the Texas Attorney General’s Office – Civil Medicaid Fraud Division conducted the investigation with assistance from DHHS - OIG. Assistant U.S. Attorney Melissa Green handled the matter.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.