Long Island Doctor Facing Medicaid Fraud Charges

Long Island Doctor Indicted and Sued for Health Care Fraud

In an August 1, 2022, press release, NY Attorney General (AG) Letitia James announced that a Kings Point physician was being indicted for defrauding Medicare. Dr. Payam Toobian, MD, was charged with “third-degree larceny, third-degree health care fraud, eight counts of falsifying business records in the first degree,” and three counts of violating laws prohibiting kickbacks under the NY state Medicaid program.

The AG’s office has also filed a civil suit against Toobian and others for violating the federal and state False Claims Acts.

NY AG Investigation Reveals Doctor’s Bribery and Kickback Scheme 213

It is unclear how the AG’s office began investigating Dr. Toobian and America’s Imaging Center, Inc. America’s Imaging Center is Dr. Toobian’s corporation that operated Empire Imaging, a diagnostic radiology center in Queens, NY.

The investigation revealed that from 2006 to 2017, Toobian committed, among other things, numerous felonies, Medicare fraud, or violations of the False Claims Act by:

  • Forcing patients to get unnecessary tests
  • Forcing patients to get unnecessarily invasive tests and seeking reimbursement
  • Telling employees at Empire Imaging to perform extra tests without the direction or approval from referring doctors
  • Bribing physicians with cash, gifts, and checks to refer patients to Empire Imaging.

Some of the unnecessary tests included:

  • MRIs of the brain
  • MRIs of the cervical spine
  • MRIs of the lumbar spine
  • Orders of all these tests with injected contrast dye

Toobian allegedly ordered his employees to submit claims to Medicaid for the unnecessary, unauthorized, and invasive testing. According to the AG’s office, the referrals from the doctors involved in the bribery alone resulted in Empire Imaging receiving more than $1 million in paid claims.

The AG’s office filed criminal charges against Toobian for various felonies related to his bribery, kickback, and fraud scheme.

Doctor Being Sued for Violating the False Claims Act

The Federal False Claims Act (FCA) makes it illegal to submit false claims to the government. It also offers protection to whistleblowers who uncover, report, or try to stop fraud against the government and gives whistleblowers a way to share in the recovery of money from entities that have violated the FCA by filing a qui tam lawsuit.

The New York State FCA also gives individuals the right to file a qui tam lawsuit and share in the recovery.

Whistleblowers Can Come Forward and Report Fraud

It is unclear who, in the case of Dr. Toobian, alerted the AG to the fraudulent activities of the doctor. Often, an employee is the whistleblower who reports that false claims are being submitted to the government. Reporting fraud can be tricky, but the FCA makes retaliation for doing so illegal. An employer may not discriminate or retaliate against an employee in this situation.

The FCA also allows an individual, the whistleblower, to file a lawsuit on behalf of the government. This qui tam claim can also be an incentive to report fraud. If successful, the whistleblower can collect up to 30% of the money recovered for the government.

FCA violations are most common in health care, where doctors, hospitals, nursing homes, and imaging centers see many patients receiving Medicaid. Every time that office submits a claim for reimbursement from Medicaid, it is submitting a claim to the government. Any fraudulent claim – for an unnecessary test, a patient it did not treat, or an inflated cost- can violate the FCA.

Whistleblowers: Call Alonso Krangle, LLP to Protect Your Rights

If you become aware of Medicaid fraud, call our lawyers today. We can help you understand your rights as a whistleblower under the FCA and pursue any compensation you are entitled to. Call us today at (800) 403-6191 for a free whistleblower consultation.

DOJ Record Recovery Under FCA

US DOJ Collects Record Amounts Under False Claims Act In 2021

In its last fiscal (FY) year, which ended in September 2021, the US Department of Justice (US DOJ) collected more than $5.6 billion under the False Claims Act (FCA). This recovery, achieved through settlements and legal judgments, is the highest since 2014. According to the DOJ, it is also the second-largest annual total in the history of the False Claims Act.

In cases brought by whistleblowers, the DOJ collected more than 1.5 billion in the fiscal year 2021.

What Is The False Claims Act?

The False Claims Act is a federal statute that allows the US DOJ to pursue claims against people and businesses that commit fraud against the government. Anyone who knowingly submits a false claim to the government is liable for significant damages and penalties.

The origin of the False Claims Act dates back to 1863 when it was enacted in response to fraud by defense contractors during the Civil War.

The FCA also allows private citizens to bring claims on behalf of the government in what are called “qui tam” claims. If the government is successful in these cases, the private citizen or “whistleblower” who initiated the claim shares in the recovery. The whistleblower can often receive 25-30% of the government’s recovery.

What Were The Big Cases In 2021?

In 2021, most (nearly 5 billion) of the DOJ’s billions in recovery came from healthcare-related fraud. Many claims under the FCA involved medical device manufacturers, medical labs, doctors, hospice organizations, pharmacies, and hospitals.

The largest portion of the billions recovered in 2021 resulted from settlements with the manufacturers of opioids. Indivior and Purdue Pharma agreed to huge payouts related to their drugs, Suboxone and OxyContin, respectively. Purdue alone made a 2.8 billion dollar payment.

Some of the larger false claim settlements involved issues such as:

  • Unnecessary medical services ordered with no regard for actual patient needs
  • Unlawful kickbacks to doctors and pharmacies
  • Unlawful promotion of unsafe drugs
  • False and misleading claims about medication
  • Unnecessary prescriptions of opioids and other drugs
  • Unsupported diagnostic codes- (specifically related to Medicare Advantage fraud)

The remaining False Claims Act recoveries during 2021 came from various industries. These included fraud by defense contractors, clothing companies, and state government agencies.

Call Alonso Krangle, LLP

It is unlawful to submit false claims to the government knowingly. If you are aware of fraud against the government, you might be entitled to initiate a qui tam (“whistleblower”) claim.

Call Alonso Krangle, LLP, at 800-403-6191 today to determine if you are eligible to initiate a case under the False Claims Act.