A New York federal court on Tuesday affirmed the U.S. Department of Health and Human Services’ (HHS’s) decision to deny a Manhattan physician’s access to federal health care programs for 11 years.
Hameedi made false reports about patients’ symptoms, medical histories, and test results to insurance providers such as Medicare and Medicaid while presiding over a clinic that specializes in neurology and cardiology from 2003 to 2015.
In presenting the fraudulent reports, he sought to obtain preauthorization for procedures and medical tests.
He was sentenced to 20 months in prison and ordered to pay $554,331 in restitution.
In 2022, the HHS Office of the Inspector General (OIG) notified Hameedi that he would be excluded from federal health program access for 11 years.
The OIG based this decision on the fact that the fraudulent activity resulted in a financial loss of more than $50,000 to a government agency—the minimum threshold in the federal statute—and because Hameedi’s conviction involved incarceration.
Hameedi appealed the 11-year exclusion and got it reduced to eight years, but HHS Secretary Xavier Becerra filed his own appeal on that decision, and the 11-year exclusion period that was formerly deemed unreasonable was reinstated.
Becerra is authorized to exclude entities from federal health programs under Title 42 of the U.S. Code.
“The purpose of the exclusion is to protect all federal health care programs from ‘fraud and abuse, and to protect beneficiaries of those programs from incompetent practitioners and from inappropriate or inadequate care,’” the complaint stated. “The Secretary is required to exclude any individual who has been convinced of a felony offense relating to health care fraud from participation in any federal health care program for at least five years.”
Hameedi argued that the 11-year restriction was unreasonable because it wasn’t supported by evidence and that Becerra “incorrectly relied on the full court-ordered restitution amount in applying the financial loss aggravating factor rather than the restitution he actually paid in the underlying criminal case.”
Instead, Becerra should have based his decision on Hameedi’s 2021 divided settlement with a co-defendant that left him responsible for only $198,657 of the total $554,331, Hameedi argued.
The court concluded that Becerra appropriately considered all penalties, including Hameedi’s sentencing and amount of restitution when calculating the 11-year restriction phase.
“In considering the record as a whole, the Court finds that the Secretary’s decision applied the correct legal standard, was supported by substantial evidence, was not arbitrary and capricious, and afforded Plaintiff the process he was due,” the court ruled.
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