Description: Newark, New Jersey civil litigation lawyers represented Defendants accused for violating the False Claims Act.

Moustafa Moustafa M.D. and his medical practice, South Carolina Nephrology and Hypertension Center Inc., of Orangeburg and Bamberg, South Carolina, agreed to pay $585,540 to resolve False Claims Act allegations that they received illegal kickbacks in violation of the Anti-Kickback Statute in return for referring patients for laboratory testing. Moustafa and his practice have agreed to cooperate with the Department of Justice’s investigations of, and litigation against, other participants in the alleged kickback schemes.

“Kickbacks have no place in our healthcare system. Health care providers and clinical laboratories are on notice that benefits in exchange for referrals are improper, and may violate the Anti-Kickback Statute. We will continue to pursue those who enter into unlawful arrangements that waste taxpayer dollars and improperly influence healthcare providers’ medical judgments.”

U.S. Attorney Philip R. Sellinger

“Financial inducements to healthcare providers can influence medical decisions and undermine the integrity of public healthcare programs,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said. “We will continue to hold accountable those who participate in kickback arrangements, including unlawful arrangements involving clinical laboratory testing.”

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded healthcare programs. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.

The settlement announced today resolves allegations that Moustafa and his practice received kickbacks in violation of the Anti-Kickback Statute in return for Moustafa’s laboratory referrals and caused the submission of false or fraudulent claims to Medicare and TRICARE.

Office Rent and Phlebotomy Kickbacks. From June 2017 to December 2021, Moustafa and his practice allegedly received thousands of dollars in remuneration disguised as purported office space rental and phlebotomy payments, paid monthly or in a lump sum money order, from a clinical laboratory in Anderson, South Carolina, in return for Moustafa’s laboratory referrals.

Clinical Staff Kickbacks. From August 2020 to December 2022, Moustafa and his practice allegedly received from a clinical laboratory in Kenilworth, New Jersey, remuneration in the form of free clinical staff to provide services to Moustafa’s practice unrelated to that laboratory, in return for Moustafa’s referrals for laboratory testing.

Consulting and Medical Director Kickbacks. From September 2019 to March 2023, Moustafa allegedly received from marketing company Ralston Health Group, Inc. (Ralston) thousands of dollars in remuneration disguised as consulting and medical director payments, paid monthly, in return for Moustafa ordering clinical laboratory services from five laboratories. The settlement resolves allegations that Ralston kicked back to Moustafa a portion of the commissions those five laboratories paid to Ralston, in return for Moustafa ordering laboratory testing from those laboratories.

“Rooting out healthcare fraud is a priority in the District of South Carolina,” U.S. Attorney Adair F. Boroughs for the District of South Carolina said. “Kickbacks raise costs for taxpayers and undermine our healthcare programs by leading to unnecessary medical services. We are committed to holding those who give and receive illegal kickbacks accountable.”

“Health care providers who accept kickbacks can allow greed to influence their medical decision-making, putting patients and their healthcare programs at risk of harm,” Naomi Gruchacz, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), said. “HHS-OIG is proud to work alongside our law enforcement partners to protect HHS programs from abuse and ensure that patient needs drive providers’ decisions."

“Kickback schemes have no place in federal healthcare programs and will not be tolerated,” Special Agent in Charge Christopher Dillard, Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office, said. “DCIS and our partner agencies continue to stand firm in our dedication to protect the integrity of these programs.”

The settlements were the result of a coordinated effort between the U.S. Attorney’s Offices for the District of New Jersey and South Carolina and the Civil Division’s Commercial Litigation Branch, Fraud Section, with assistance from HHS-OIG, FBI, and DCIS.

The government is represented by Assistant U.S. Attorney Kruti Dharia of the U.S. Attorney’s Office, District of New Jersey, Opioid Abuse Prevention and Enforcement Unit, Assistant U.S. Attorney Beth C. Warren in the U.S. Attorney’s Office for the District of South Carolina, and Senior Trial Counsel Christopher Terranova in the Civil Division’s Commercial Litigation Branch (Fraud Section).

The government’s pursuit of these matters illustrates the government’s 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 1-800-HHS-TIPS (800-447-8477).

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

Outcome: Defendants agreed to pay $585,540.

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