Appeals court revives whistleblower suits alleging unqualified broker made radiology referral decisions
A California appeals court has revived two whistleblower lawsuits alleging a broker with no medical background made decisions relating to radiology referrals to boost the value of his businesses.
Allstate Insurance Co. first filed the complaints in 2020 against Discovery Radiology Physicians, OneSource Medical Diagnostics and four physicians, alleging insurance fraud. The suits center around Sattar Mirtabatabaee, who also goes by Sattar Mir and has no medical license. He allegedly ran medical practices that referred auto and worker’s comp claimants to radiologists, producing inflated bills from which he benefited, the Claims Journal reported Aug. 18.
A Los Angeles County Superior Court judge had previously dismissed the complaints. However, an appellate court panel has reversed the decision, allowing the suit to march forward.
The Coalition Against Insurance Fraud (CAIF) filed an amicus brief in the case, noting that insurers have seen a “nationwide surge in medical corporations guiding treatment for business purposes rather than patient care,” the report noted. CAIF believes the recent ruling affirms that the state’s Insurance Fraud Prevention Act can be used to “shut down the illegal corporate practice of medicine by nonphysicians.”
“The vast majority of medical practices are doing a fabulous job for their patients,” Matthew J. Smith, executive director of CAIF, told the Claims Journal. “What we are talking about here, and what the coalition is focusing on, is the fraudsters and the scammers. They are realizing that the quicker they can run up the bills, the more money they can make before someone looks into it.”
Allstate’s original complaint contends that Mirtabatabaee owns three medical groups purported to be providers of imaging services. However, they actually have acted as brokers, funneling patients to radiology facilities that have contracts with Mirtabatabaee’s companies. The businessman allegedly controlled both sides of the referrals, which exchanged kickbacks or a fee-split and then marked up costs for services when submitting bills to Allstate and other insurers.
You can read more about the case, including why the superior court struck down the suit prior to the appeal, here:
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.