SC: Physician and Nephrology Practice Agree to Pay Over $585,000 to Settle Laboratory Kickback Allegations

Healthcare Facility Rx Drug Diversion – Illegal Kickbacks

Moustafa Moustafa, M.D. and his medical practice, South Carolina Nephrology and Hypertension Center Inc., of Orangeburg and Bamberg, South Carolina, have 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. Dr. Moustafa and his practice have agreed to cooperate with the Justice Department’s investigations of, and litigation against, other participants in the alleged kickback schemes.

“Financial inducements to healthcare providers can influence medical decisions and undermine the integrity of public healthcare programs,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “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 Dr. Moustafa and his practice received kickbacks in violation of the Anti-Kickback Statute in return for Dr. 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, Dr. 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 Dr. Moustafa’s laboratory referrals.
• Clinical Staff Kickbacks. From August 2020 to December 2022, Dr. 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 Dr. Moustafa’s practice unrelated to that laboratory, in return for Dr. Moustafa’s referrals for laboratory testing.
• Consulting and Medical Director Kickbacks. From September 2019 to March 2023, Dr. 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 Dr. Moustafa ordering clinical laboratory services from five laboratories. The settlement resolves allegations that Ralston kicked back to Dr. Moustafa a portion of the commissions those five laboratories paid to Ralston, in return for Dr. Moustafa ordering laboratory testing from those laboratories.

“Rooting out healthcare fraud is a priority in the District of South Carolina,” said U.S. Attorney Adair F. Boroughs for the District of South Carolina. “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.”

“Kickbacks have no place in our healthcare system,” said U.S. Attorney Philip R. Sellinger for the District of New Jersey. “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.”

“Healthcare providers who accept kickbacks can allow greed to influence their medical decision-making, putting patients and their healthcare programs at risk of harm,” said Special Agent in Charge Naomi Gruchacz of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “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,” said Special Agent in Charge Christopher Dillard of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office. “DCIS and our partner agencies continue to stand firm in our dedication to protect the integrity of these programs.”

The settlement was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorneys’ Offices for the Districts of South Carolina and New Jersey, with assistance from the Federal Bureau of Investigation, HHS-OIG and DCIS.  The settlement announced today was handled by Senior Trial Counsel Christopher Terranova in the Civil Division’s Commercial Litigation Branch (Fraud Section), Assistant U.S. Attorney Beth C. Warren for the District of South Carolina and Assistant U.S. Attorney Kruti Dharia for the District of New Jersey.

The government’s pursuit of this matter illustrates the government’s emphasis on combating healthcare 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 settlement are allegations only, and there has been no determination of liability.