A settlement has been reached to resolve False Claims Act allegations against Beaver Medical Group L.P. and one of its physicians, Dr. Sherif Khalil.
The allegations arose from a lawsuit that claimed Beaver Medical Group L.P. and one of its physicians, Dr. Sherif Khalil, have agreed to pay roughly $5 million to resolve allegations that they reported invalid diagnoses to Medicare Advantage plans and thereby caused those plans to receive inflated payments from Medicare.
“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,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
Medicare Advantage Program, also known as “Medicare Part C,” is a program where those receiving Medicare may opt to get healthcare coverage through private insurance plans that are owned and operated by private insurers. Medicare pays these insurers a fixed, monthly amount to provide care to people with Medicare who enroll in their plans. The monthly amount paid typically depends on the health of the beneficiaries.
According to the government, several insurers in California contracted with Beaver to provide healthcare to people with Medicare. As a contractor, Beaver got a share of the payments the insurers received from Medicare for patients who were under Beaver’s care. Beaver, therefore, had a financial incentive to submit additional diagnosis codes to insurers to hike up the payments received from Medicare.
The whistleblower, Dr. David Nutter, a former Beaver employee will receive about $850,000 from the settlement.
