Expert Witness Medicare Fraud Damages
Expert Witness Medicare Fraud Damages qualifications affirmed by U.S. District Judge Lew Ninth Circuit, Central District of California. Michael Arrigo was affirmed as an expert by U.S. District Judge Ronald Lew, Central District of California. Arrigo is retained by a firm representing a Relator (commonly known as a ‘whistleblower’) who identified alleged illegal practices involving Medicare Fraud, Medicaid Fraud (Medi-Cal Fraud in California) as well as violations of anti-kickback statute.
See below to view the Judge’s Ruling published in Westlaw:
View in Full Screen
United States v. Pacific Health Corporation, Slip Copy (2018)
© 2018 Thomson Reuters. No claim to original U.S. Government Works.
1
2018
WL 1026361
Only the Westlaw citation is currently
available.
United States District Court, C.D.
California.
UNITED STATES of America, State of
California ex rel. Julie A. Macias,
Plaintiff,
v.
PACIFIC HEALTH CORPORATION, a
Georgia corporation; Los Angeles
Doctors Hospital Corporation, a
California corporation; SGG, Inc., a
California corporation; PROCare
Mobile Response LLC, a California
limited liability company; Karen
Triggiani, an individual;
Robert
Barrett, an individual; Keivan
Golchini, M.D., an individual; Farhad
Khossoussi, M.D., an individual; Alan
Markie, M.D., an individual; and Litos
O. Mallare, M.D., an individual,
Defendants.
CV 12–
00960–
RSWL
–AJWx
|
Signed 02/20/2018
Attorneys and Law Firms
Brent A. Whittlesey, AUSA—Office of US
Attorney Civil Fraud Section, Los Angeles,
CA,
Elizabeth Young
, US Department of
Justice Commercial Litigation—Fraud
Section, Washington, DC,
Carey G. Been,
David Michael Watson,
Alexander S.
Vahdat,
Eric A. Grover,
Jeffrey F. Keller
,
Kathleen R. Scanlan,
Sarah Renee Holloway,
Keller Grover LLP, San Francisco, CA, for
Plaintiff.
Pacific
Health Corporation, Los Angeles,
CA, pro se.
Los Angeles Doctors Hospital Corporation,
Los Angeles, CA, pro se.
James W. Spertus,
Dolly Kae Hansen,
Spertus Landes and Umhofer LLP, Benjamin
N Gluck,
Marc E. Masters
,
Paul W.
Moskowitz, Bird Marella Boxer Wolpert
Nessim Drooks Lincenberg & Rhow, Eric
Meier Gruzen, Peckar and Abramson PC,
Marc R. Greenberg, Musick Peeler and
Garrett LLP, Los Angeles, CA, for
Defendants.
Opinion
ORDER RE: DEFENDANT FARHAD
KHOSSOUSSI, M.D.
’S MOTION TO
EXCLUDE EXPERT TESTIMONY
[351];
DEFENDANT FARHAD
KHOSSOUSSI, M.D.
’S MOTION FOR
SUMMARY JUDGMENT
[349];
RELATOR
’S MOTION FOR PARTIAL
SUMMARY JUDGMENT
[348]
RONALD S.W. LEW
, Senior U.S. District
Judge
*1
Currently before the Court is Defendant
Farhad Khossoussi, M.D.
’s (
“Dr.
Khossoussi”) Motion for Summary Judgment
[349] and Motion to Exclude Expert
Testimony of Michael
Arrigo
[351]
(“Motion to Exclude”), and Relator Julie
Expert
Witness
Medicare
Fraud,
Medical
Coding,
Medical
Billing,
Damages
Calculations
Michael
Arrigo
https://noworldborders.com/expert-witness/
Local
coverage
determinations,
national
coverage
determinations
United States v. Pacific Health Corporation, Slip Copy (2018)
© 2018 Thomson Reuters. No claim to original U.S. Government Works.
2
Macias
’ (“Relator”) Motion for Partial
Summary Judgment as to Affirmative
Defenses [348] (“Motion for Partial
Summary Judgment”). Having reviewed all
papers submitted pertaining to these Motions,
the Court
NOW FINDS AND RULES AS
FOLLOWS:
the Court
GRANTS in part
and DENIES in part
Dr. Khossoussi’s
Motion to Exclude,
GRANTS
Dr.
Khossoussi’s Motion for Summary
Judgment, and
DENIES as MOOT
Relator’s
Motion for Partial Summary Judgment.
I. BACKGROUND
A.
Factual Background
Relator was a registered nurse on the
Psychiatric Evaluation Team (“PET
”) at the
Los Angeles Metropolitan Medical Center
(“LAMMC”). Am. Compl. ¶
6, ECF No. 31.
From April 2003 to July 2012, Relator was
employed as a member of LAMMC’s PET to
conduct psychiatric evaluations for
involuntary commitments pursuant to
California Welfare and Institutions Code
section 5150 (“5150 holds”). Id. ¶ 162.
SGG Inc. (“SGG”) was a California
corporation with its principal place of
business in San Marino, California. Id. ¶ 12.
SGG was primarily engaged in the health
services industry,
including hospital
marketing. Id.
Karen Triggiani (“Triggiani”)
is an individual who founded SGG in 1997
and was its sole shareholder from March 20,
1998 until August 15, 2007.
Id. Robert
Barrett (
“Barrett
”) is Triggiani’s husband,
who was the sole shareholder of SGG from
December 27, 2007 to August 1, 2009. Id.
Keivan Golchini, M.D. (“Dr. Golchini”) is a
doctor specializing in internal medicine, who
was the sole shareholder of SGG from
August 1, 2009 through December 26, 2012
when SGG was dissolved.
Id. ¶¶
12, 16.
Triggiani was excluded from Medicare on
June 19, 2008 after being convicted of
conspiracy to commit Medicare fraud.
Id. ¶
217.
Dr. Khossoussi is a practicing psychiatrist
who was granted privileges to practice in the
psychiatry department at LAMMC. Decl. of
Farhad Khossoussi, M.D. in Supp. of Mot.
for Summ. J. (“Khossoussi Decl.
”)
¶¶ 2–3,
ECF No. 353.
Allegedly, pursuant to a sham contract with
LAMMC, SGG (and in particular Triggiani)
would recruit patients from outside facilities
and refer them to LAMMC in exchange for
kickback payments.
1
Am. Compl. ¶¶ 204–
211. Relator alleges that Dr. Khossoussi
admitted and treated these patients knowing
the referrals were in exchange for kickbacks.
Id. ¶
327. Dr. Khossoussi, according to
Relator, then billed to government healthcare
programs the services he provided to these
patients. Id.
Relator further alleges that Dr.
Khossoussi continued to use SGG’s and
Triggiani’s services even after Triggiani was
convicted of conspiracy to commit Medicare
fraud and excluded from Medicare. Id.
¶¶
212–264. Relator alleges that LAMMC and
Dr. Khossoussi also attempted to conceal
Triggiani’s continued involvement. Id.
B.
Procedural Background
*2
Relator filed the original Complaint [1] in
Expert
Witness
Medicare
Fraud,
Medical
Coding,
Medical
Billing,
Damages
Calculations
Michael
Arrigo
https://noworldborders.com/expert-witness/
Local
coverage
determinations,
national
coverage
determinations
United States v. Pacific Health Corporation, Slip Copy (2018)
© 2018 Thomson Reuters. No claim to original U.S. Government Works.
3
this Action on February 3, 2012, naming
Pacific Health Corporation (
“PHC”), Los
Angeles Doctors Hospital Corporation
(“LADHC”), and SGG as Defendants. The
United States declined to intervene on May
22, 2013. See
U.S.
’s Notice of Election to
Decline Intervention, ECF No. 19.
On August 20, 2013, Relator filed an
Amended Complaint [31] in this Action,
newly naming PROCare Mobile Response
LLC (“PROCare”), Triggiani, Barrett, Dr.
Golchini, Dr. Khossoussi, Alan Markie, M.D.
(“Dr. Markie”), and Litos O. Mallare, M.D.
(“Dr. Mallare”) as Defendants.
2
The State of
California declined to intervene on February
11, 2014. See
Cal.’s
Notice of Election to
Decline Intervention, ECF No. 36. As a
result, the Court ordered that the seal be lifted
and that the Complaint and Amended
Complaint be served on Defendants. See
Order re Unsealing of Compl., ECF No. 37.
Dr. Khossoussi filed his Motion for Summary
Judgment [349] and Motion to Exclude [351]
on November 10, 2017. Relator filed her
Motion for Partial Summary Judgment [348]
that same day. Relator and Dr. Khossoussi
filed their Oppositions [396, 398, 400] to
each other’s respective Motions on
December 15, 2017. Relator and Dr.
Khossoussi filed Replies [418, 420, 424] in
support of their Motions on January 8, 2018.
II. DISCUSSION
A.
Legal Standard
1. Motion
to Exclude Expert Testimony
Expert testimony is admissible pursuant to
Federal Rule of Evidence 702
if it is relevant
and reliable. Daubert v. Merrell Dow Pharm.,
Inc.
, 509 U.S. 579, 589 (1993). Testimony is
relevant if it will assist the trier of fact in
understanding a fact at issue. Id.
at 591–92.
As to the reliability requirement, the court
must act as a
“gatekeeper”
to exclude “junk
science”
by making a preliminary
determination that the expert’s testimony is
reliable. Id.
Expert testimony must be the
product of: (1) sufficient facts or data, (2)
reliable principles and methods, and (3) the
reliable application of those principles and
methods to the facts of the case. Fed. R. Evid.
702.
The court must determine whether the
testimony has “a reliable basis in the
knowledge and experience of [the relevant]
discipline.”
Kumho Tire Co., Ltd. v.
Carmichael, 526 U.S. 137, 149
(1998)(quoting
Daubert, 509 U.S. at 592).
The court examines the data and
methodology that form the bases for the
expert’s opinion and has broad discretion in
determining the reliability of such opinions.
Id.
at 152.
2.
Motion for Summary Judgment
Federal Rule of Civil Procedure 56(a)
states
that a “court shall grant summary judgment”
when the movant “shows that there is no
genuine dispute as to any material fact and
the movant is entitled to judgment as a matter
of law.
” A fact is
“material
” for purposes of
summary judgment if it might affect the
outcome of the suit, and a “genuine issue”
exists if the evidence is such that a reasonable
Expert
Witness
Medicare
Fraud,
Medical
Coding,
Medical
Billing,
Damages
Calculations
Michael
Arrigo
https://noworldborders.com/expert-witness/
Local
coverage
determinations,
national
coverage
determinations
United States v. Pacific Health Corporation, Slip Copy (2018)
© 2018 Thomson Reuters. No claim to original U.S. Government Works.
4
fact-finder could return a verdict for the non-
moving party. Anderson v. Liberty Lobby,
477 U.S. 242, 248 (1986). The evidence, and
any inferences based on underlying facts,
must be viewed in the light most favorable to
the opposing party. Twentieth Century
–Fox
Film Corp. v. MCA, Inc., 715 F.2d 1327,
1329 (9th Cir. 1983). In ruling on a motion
for summary judgment, the court’s function
is not to weigh the evidence, but only to
determine if a genuine issue of material fact
exists.
Anderson, 477 U.S. at 255.
*3
Under
Rule 56(a), the party moving for
summary judgment has the initial burden to
show “no genuine dispute as to any material
fact.”
See
Nissan Fire & Marine Ins. Co. v.
Fritz Cos., 210 F.3d 1099, 1102–03 (9th Cir.
2000). The burden then shifts to the non-
moving party to produce admissible evidence
showing a triable issue of fact.
Id.; see
Fed.
R. Civ. P. 56(a). Summary judgment
“is
appropriate when the plaintiff fails to make a
showing sufficient to establish the existence
of an element essential to [her] case, and on
which [she] will bear the burden of proof at
trial.”
Cleveland v. Policy Mgmt. Sys. Corp.
,
526 U.S. 795, 805–06 (1999); see
Celotex
Corp. v. Catrett, 477 U.S. 317, 322 (1986).
The standard for a motion for summary
judgment “provides that the mere existence
of
some
alleged factual dispute between the
parties will not defeat an otherwise properly
supported motion for summary judgment; the
requirement is that there be no
genuine
issues
of
material
fact.”
Anderson, 477 U.S. at 247–
48.
B. Analysis
1.
Motion to Exclude
Mr. Arrigo offers two opinions regarding Dr.
Khossoussi in the form of damages
calculations. The first opinion is, essentially,
that it was impossible for Dr. Khossoussi to
work the hours for which he billed. See
Decl.
of Eric Grover in Supp. of Relator
’s Opp’n to
Mot. to Exclude (“Grover Mot. to Exclude
Opp’n Decl.
”), Ex. 1 (“Arrigo Report”) at 72,
ECF No. 398–2. The second opinion involves
the damages attributable to (1) the claims Dr.
Khossoussi submitted, or caused LAMMC to
submit, for patients Triggiani referred
pursuant to the alleged kickback scheme and
(2) for case management and discharge
planning services Triggiani allegedly
provided to Dr. Khossoussi’s patients in
violation of her Medicare exclusion. Id.
at 14.
a.
Mr. Arrigo’s Opinion Regarding Hours
Worked
In his Report, Mr. Arrigo opines that it was
impossible for Dr. Khossoussi to work the
402,850 minutes he billed over a six-and-a-
half-year period. See
id.
at 72. However,
Relator fails to allege in the Amended
Complaint that Dr. Khossoussi was unable to
work the time he billed to Medicare.
Further, Dr. Khossoussi argues that Mr.
Arrigo’s opinions regarding the possibility of
Dr. Khossoussi working the time he billed are
unfounded and irrelevant to Relator
’s
remaining claims. Because Relator has failed
to offer any opposition to these arguments,
any opposition is waived. See
Zixiang Li v.
Kerry, 710 F.3d 995, 1000 (9th Cir.
2013)(“[A] party waives an argument by
Expert
Witness
Medicare
Fraud,
Medical
Coding,
Medical
Billing,
Damages
Calculations
Michael
Arrigo
https://noworldborders.com/expert-witness/
Local
coverage
determinations,
national
coverage
determinations
“Accordingly, the Court finds that Mr. Arrigo has sufficient specialized knowledge to provide an opinion on the potential Medicare damages.”
“Mr. Arrigo clearly has the relevant qualifications necessary to provide an opinion regarding the potential damages from submission of allegedly false claims. Mr. Arrigo has experience in both state and federal court providing expert opinions that involved medical billing, coding, Medicare, and Medi–Cal. See Arrigo Report, Ex. F. Mr. Arrigo also has training in medical coding and billing reimbursement, and he has spoken on the topic of electronic health records. See Grover Mot. to Exclude Opp’n Decl., Ex. 2. Accordingly, the Court finds that Mr. Arrigo has sufficient specialized knowledge to provide an opinion on the potential Medicare damages.” Expert Witness Medicare Fraud Damages. Expert Medicare Coverage Determinations.
Mr. Arrigo’s opinions do not boil down to simple math. As Mr. Arrigo notes in his Report, he calculated the potential damages by first reviewing patient medical records and Medicare bills
Relator’s counsel provided and matching patient medical numbers in these records. (Arrigo Report 47–52). Mr. Arrigo needed to have knowledge about Medicare billing practices as well as billing codes and the breakdown of medical billing. Therefore, Mr. Arrigo’s opinion is not so simple. Reviewing thousands of pages of medical records and billing is a complicated and time-intensive endeavor.
Related Posts