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United States v. Patel

United States Court of Appeals for the Seventh Circuit

December 5, 2014, Argued; February 10, 2015, Decided

No. 14-2607

Opinion

 [*608]  Flaum, Circuit Judge. Dr. Kamal Patel is a Chicago-area physician who commonly prescribes home health care services for his patients. After federal investigators learned that Patel  [*609]  had been receiving undisclosed payments from Grand Home Health Care ("Grand"), a home care provider used by some of his patients, Patel was charged with six counts of violating—and one count of conspiring to violate—42 U.S.C. § 1320a-7b, otherwise known as the Anti-Kickback Statute. In relevant part, ] the Statute makes it illegal to "knowingly and willfully solicit[] or receive[] any remuneration (including any kickback, bribe, or rebate) ... in return for referring an individual to a person for the furnishing" of health care services paid for, in whole or in part, by a [**2]  federal health care program. Id. § 1320a-7b(b)(1)(A).

During his bench trial, at the close of the government's evidence, Patel moved for a judgment of acquittal, arguing that he had not "referred" any patients to Grand because there was no evidence that he steered or directed his patients to Grand; rather, the patients independently chose Grand as their provider after Patel prescribed home health care. The district court rejected Patel's argument, holding that, even if a patient had initially chosen Grand, Patel "referred" the patient to Grand when he certified or recertified that the patient needed care, that the care would be provided by Grand, and that Grand could be reimbursed by Medicare for services provided. This certification and recertification occurred each time Patel signed a standardized Medicare form, Form 485, for one of his patients.

On appeal, Patel argues that the district court erred by holding that the certification and recertification, via Form 485, of patients for treatment constitutes a "referral" under the Anti-Kickback Statute. He also argues that even if those certifications were referrals, there was insufficient evidence to conclude that Patel was paid "in return for" certifications, [**3]  as required by the statute. We affirm.

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778 F.3d 607 *; 2015 U.S. App. LEXIS 2099 **

UNITED STATES OF AMERICA, Plaintiff-Appellee, v. KAMAL PATEL, Defendant-Appellant.

Prior History:  [**1] Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No. 12 CR 491-5 — Robert M. Dow, Jr., Judge.

United States v. Patel, 17 F. Supp. 3d 814, 2014 U.S. Dist. LEXIS 20256 (N.D. Ill., Feb. 19, 2014)

CORE TERMS

patients, provider, referral, certification, kickback, recertification, recommend, home health care, argues, district court, authorization, conspiracy, signatures, recertifying, certifying, Dictionary, gatekeeper, convicted, directing, meetings, therapy, counts, usage, words

Public Health & Welfare Law, Providers, Payments & Reimbursements, Abuse & Fraud, Medicare, General Overview, Reimbursement, Types of Providers, Civil Procedure, Appeals, Standards of Review, De Novo Review, Governments, Legislation, Interpretation, Medicaid, Interpretation, Rule of Lenity, Criminal Law & Procedure, Substantial Evidence, Sufficiency of Evidence