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Beaver Medical Group L.P. and Dr. Sherif Khalil, Medicare Fraud, California 2023
California-based Beaver Medical Group L.P. and one of its physicians, Dr. Sherif Khalil, have agreed to pay a total of $5,039,180 to resolve allegations that they reported invalid diagnoses to Medicare Advantage plans and thereby caused those plans to receive inflated payments from Medicare.
The allegations originated from a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act by Dr. David Nutter, a former employee of Beaver. Dr. Nutter will receive approximately $850,000.
The Justice Department announced the settlement, citing Assistant Attorney General Jody Hunt of the Civil Division: “The United States relies on healthcare providers to submit accurate diagnosis data to Medicare Advantage plans to ensure those plans receive the appropriate compensation from Medicare.
We will pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
Under the Medicare Advantage program, Medicare beneficiaries may opt to obtain health care coverage through private insurance plans that are owned and operated by private insurers known as Medicare Advantage Organizations (MAOs).
These MAOs often contract with physician groups and other healthcare providers to provide care to Medicare beneficiaries enrolled in their plans. The settlement resolves allegations that Beaver and Dr. Khalil knowingly submitted diagnoses that were not supported by the beneficiaries’ medical records in order to inflate the payments that the MAO received from Medicare.
“As enrollment in Medicare Advantage continues to grow, investigation into accuracy of diagnosis data becomes ever more important,” said Timothy B. Francesca, Acting Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.
“Those who inflate bills sent to government health programs can expect to pay a heavy price.”
The settlement was handled by the Civil Division’s Commercial Litigation Branch and the Department of Health and Human Services, Office of Inspector General.
The case is docketed as United States ex rel. David Nutter, M.D., and David Nutter, M.D., individually, v. Sherif F. Khalil, M.D., Beaver Medical group, L.P., The Beaver Medical Clinic, Inc., Epic Management, L.P., and Epic Management, Inc., No. CVC17-02035-PSG-KKX (C.D. Cal).
The government’s intervention in this matter illustrates its 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).
Key Facts
- State: California
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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