Date: 08-17-2016

Case Style: United States of America v. Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital

Case Number: 2:05-cv-06730-MAM

Judge: Mary A. McLaughlin

Court: United States District Court for the Eastern District of Pennsylvania (Philadelphia County)

Plaintiff's Attorney: Gregory B. David and Michael S. Macko for the United States of America

Defendant's Attorney: Not Available

Description: Philadelphia, PA - Doctors and Medical Facilities in Lehigh Valley Pay $690,441 to Resolve Healthcare Fraud Allegations

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, have agreed to pay $690,441 to the federal government to resolve allegations that they violated the False Claims Act by submitting false health care billings to the Medicare, Federal Employees Health Benefits, and United States Department of Labor-Office of Workers’ Compensation programs.

The settlement resolves allegations in a complaint filed in federal court in the Eastern District of Pennsylvania by a whistleblower under the qui tam provisions of the False Claims Act. The qui tam provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblower, Margaret Reynard, will receive approximately $124,000 of the recovery.

In the qui tam complaint, the whistleblower alleged that the defendants submitted claims to the federal government to receive reimbursement for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising. Billing services as “incident to” a physician’s supervision commands a higher reimbursement rate than billing those same services without physician supervision. Because physicians were not available to provide the supervision that the government programs required, the whistleblower alleged that defendants’ “incident to” billing was improper and resulted in false claims during the period from July 1, 2007 through December 31, 2013. There has been no determination of civil liability. The settled civil claims are allegations only.

As part of the settlement agreement, the defendants also agreed that, for the next thirty months, they will not submit claims to federal payors for any services performed by non-physician providers under the rate that applies for services rendered “incident to” the services of a physician, regardless of whether or not the claims could be billed properly in that manner.

This case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, the U.S. Office of Personnel Management Office of the Inspector General, the U.S. Postal Service Office of the Inspector General, and the U.S. Department of Labor Office of the Inspector General.

Title 31 U.S.C. Section 3729 - False Claims

(a) Liability for Certain Acts.—
(1)In general.—Subject to paragraph (2), any person who—
(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;
(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);
(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;
(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;
(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or
(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,
is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Public Law 104–410 [1]), plus 3 times the amount of damages which the Government sustains because of the act of that person.
(2)Reduced damages.—If the court finds that—
(A) the person committing the violation of this subsection furnished officials of the United States responsible for investigating false claims violations with all information known to such person about the violation within 30 days after the date on which the defendant first obtained the information;
(B) such person fully cooperated with any Government investigation of such violation; and
(C) at the time such person furnished the United States with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under this title with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,
the court may assess not less than 2 times the amount of damages which the Government sustains because of the act of that person.
(3)Costs of civil actions.—
A person violating this subsection shall also be liable to the United States Government for the costs of a civil action brought to recover any such penalty or damages.
(b)Definitions.—For purposes of this section—
(1) the terms “knowing” and “knowingly”—
(A) mean that a person, with respect to information—
(i) has actual knowledge of the information;
(ii) acts in deliberate ignorance of the truth or falsity of the information; or
(iii) acts in reckless disregard of the truth or falsity of the information; and
(B) require no proof of specific intent to defraud;
(2) the term “claim”—
(A) means any request or demand, whether under a contract or otherwise, for money or property and whether or not the United States has title to the money or property, that—
(i) is presented to an officer, employee, or agent of the United States; or
(ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government’s behalf or to advance a Government program or interest, and if the United States Government—
(I) provides or has provided any portion of the money or property requested or demanded; or
(II) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and
(B) does not include requests or demands for money or property that the Government has paid to an individual as compensation for Federal employment or as an income subsidy with no restrictions on that individual’s use of the money or property;
(3) the term “obligation” means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment; and
(4) the term “material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
(c)Exemption From Disclosure.—
Any information furnished pursuant to subsection (a)(2) shall be exempt from disclosure under section 552 of title 5.
(d)Exclusion.—
This section does not apply to claims, records, or statements made under the Internal Revenue Code of 1986.

Outcome: Settled for $690,441.

Plaintiff's Experts:

Defendant's Experts:

Comments: