COLUMBIA, S.C. – In a significant crackdown on healthcare fraud, a multi-state settlement has been reached, resulting in over $1.9 million in payments from medical professionals and related entities. The Department of Justice announced that Gerald Congdon, M.D., of Pawleys Island, South Carolina; Gbenga Aluko, M.D., of Charlotte, North Carolina; Anup Banerjee, M.D., of Gastonia, North Carolina; and their respective medical practices, alongside Curis Healthcare Inc. of Chicago, Illinois, Omar Hussain of South Miami, Florida, and Saeed Medical Group Ltd. d/b/a Alliance Immediate and Primary Care of Chicago, Illinois, have agreed to resolve allegations of False Claims Act violations. These violations stemmed from their involvement in elaborate laboratory kickback schemes.
The settlements, totaling $1,913,808, underscore the government’s commitment to eradicating fraudulent practices that undermine the integrity of federal healthcare programs. A crucial component of the agreement is the parties’ commitment to cooperate with the Department of Justice’s ongoing investigations into other potential participants in these alleged schemes.
The Anti-Kickback Statute: Safeguarding Patient Interests
At the heart of this settlement lies the Anti-Kickback Statute, a federal law designed to prevent financial incentives from compromising medical judgment. This statute strictly prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, TRICARE, and other federally funded healthcare programs. By ensuring that medical decisions are based solely on patients’ best interests, the statute plays a critical role in maintaining the ethical standards of the healthcare industry.
Details of the Alleged Kickback Schemes
The settlements specifically address allegations that healthcare providers received kickbacks in exchange for referring patients to a laboratory located in Anderson, South Carolina. Furthermore, the settlements resolve allegations that a marketer and his marketing company received kickbacks from the same South Carolina laboratory for arranging laboratory testing referrals. These alleged kickbacks ultimately led to the submission of false or fraudulent laboratory testing claims to Medicare and TRICARE, violating the False Claims Act.
Specific Settlement Agreements:
- Dr. Gerald Congdon, Coastal Urgent Care, LLC, and Coastal Wellness Center, LLC: Dr. Congdon and his medical practices in Pawleys Island and Myrtle Beach, South Carolina, will pay $400,000. Allegations suggest that between May 2016 and November 2021, they received thousands of dollars in remuneration, disguised as office space rental and phlebotomy payments, from the South Carolina laboratory in return for ordering tests.
- Dr. Gbenga Aluko and Eagle Medical Center, PC: Dr. Aluko and his medical practice in Charlotte, North Carolina, agreed to pay $250,000. The allegations state that from May 2016 to November 2021, they received thousands of dollars in remuneration disguised as office space rental, phlebotomy, and toxicology payments from the South Carolina laboratory in exchange for ordering tests.
- Dr. Anup Banerjee and Gastonia Medical Specialty Clinic P.A.: Dr. Banerjee and his medical practice in Gastonia, North Carolina, will pay $206,000. It is alleged that between April 2017 and November 2021, they received thousands of dollars in remuneration disguised as office space rental and phlebotomy payments from the South Carolina laboratory in return for ordering tests.
- Omar Hussain and Curis Healthcare Inc.: Hussain and his marketing company agreed to pay $817,808. Allegations indicate that from April 2020 to August 2021, Hussain and his company received commissions from the South Carolina laboratory as independent contractors, based on the volume and/or value of Medicare and TRICARE referrals for laboratory testing that they arranged or recommended.
- Saeed Medical Group Ltd., Omar Hussain, and Curis Healthcare Inc.: Saeed Medical Group, along with Hussain and his marketing company, agreed to pay $240,000. It is alleged that between April 2020 and August 2021, Saeed Medical Group received thousands of dollars in remuneration in the form of cash payments from Hussain and his company in return for ordering tests from the South Carolina laboratory.
Statements from Law Enforcement and Government Officials
“Integrity must be the standard in our health care system,” stated Acting U.S. Attorney Brook B. Andrews for the District of South Carolina. “Kickback schemes divert funds and focus away from patients and their medical needs.
Steve Jensen, Special Agent in Charge of the FBI Columbia field office, emphasized, “The public puts immense trust in medical professionals, and disdain for the rule of law damages that trust and erodes their credibility. These settlements should serve as a reminder that the FBI and its partners are committed to holding medical practitioners accountable for kickbacks.”
Kelly Blackmon, Special Agent in Charge at the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), added, “Kickback schemes undermine medical decision-making and jeopardize the integrity of federally funded health care programs. Our commitment is to safeguard taxpayer-funded health care and the patients who rely on it, and we will rigorously pursue any allegations of False Claims Act violations.”
Special Agent in Charge Christopher Dillard of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office, stated, “The trust of the American taxpayer and the wellbeing of our Service members are undermined when laboratories and physicians engage in collusive financial relationships. DCIS will continue to work with our law enforcement partners to bring to justice medical providers who illegally enrich themselves by prioritizing kickbacks over patient care.
Collaborative Effort and Ongoing Investigations
The settlements resulted from a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the District of South Carolina, with assistance from HHS-OIG, DCIS, and the FBI. Senior Trial Counsel Christopher Terranova and Assistant U.S. Attorney Beth C. Warren handled the settlements.
This case follows previous settlements involving physicians in South Carolina, North Carolina, and Texas who received kickbacks from the same South Carolina laboratory, demonstrating the government’s persistent pursuit of healthcare fraud.
The False Claims Act: A Vital Tool in Combating Fraud
The government’s pursuit of this matter underscores its emphasis on combating healthcare fraud. The False Claims Act is a powerful tool in this effort, allowing individuals to report potential fraud, waste, abuse, and mismanagement. Tips and complaints can be reported to the Department of Health and Human Services at 1-800-HHS-TIPS (800-447-8477).
Important Disclaimer
It is crucial to note that the claims resolved by these settlements are allegations only, and there has been no determination of liability. This statement emphasizes the importance of due process and the presumption of innocence.
Impact on the Healthcare Industry
This multi-state settlement serves as a stark reminder of the severe consequences of engaging in healthcare fraud. It highlights the government’s unwavering commitment to protecting federal healthcare programs and ensuring that patient care remains the top priority. The settlements also reinforce the importance of robust compliance programs within healthcare organizations to prevent such violations.
Future Implications
The government’s continued focus on investigating and prosecuting healthcare fraud is likely to lead to increased scrutiny of financial relationships between healthcare providers, laboratories, and marketing companies. This increased scrutiny will necessitate greater transparency and adherence to ethical standards within the industry.
Call to Action
Healthcare professionals and organizations are encouraged to review their compliance programs to ensure they are in full compliance with the Anti-Kickback Statute and the False Claims Act. Reporting suspected fraud is essential in maintaining the integrity of the healthcare system.
By addressing these issues proactively, the healthcare industry can work towards building a more transparent and ethical environment that prioritizes patient care and safeguards taxpayer funds.
