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United States v. Iqbal

United States Court of Appeals, Eighth Circuit

August 23, 2017

United States of America, Plaintiff- Appellee,
Zia Iqbal, Defendant-Appellant.

          Submitted: January 13, 2017

         Appeal from United States District Court for the Eastern District of Missouri - St. Louis

          Before COLLOTON, GRUENDER, and KELLY, Circuit Judges.

          COLLOTON, Circuit Judge.

         Following a bench trial, the district court convicted Zia Iqbal on four federal criminal charges: three counts of soliciting or receiving an illegal kickback related to a federal health-care program and one count of making a false statement to federal agents. The district court[1] sentenced Iqbal to two years of probation on each count, to be served concurrently. Iqbal appeals, arguing that there was insufficient evidence to support his convictions. We affirm.


         In March 2011, Iqbal met Millie Saeger, the administrator and minority owner of Patient Care Professionals (PCP), a skilled-medical-home-care agency that provides nursing and various therapy services. Iqbal stated that he managed a large group of physicians and that the physicians were looking for home care agencies to refer their patients. He explained that he could refer patients to PCP in return for a share of the profits made from the services to those patients. Saeger said that she was not interested in the arrangement.

         Believing Iqbal's proposal to be unlawful, Saeger contacted the Office of Inspector General of the United States Department of Health and Human Services and spoke with a special agent. The agent commenced an undercover operation at PCP with the hope of obtaining audio or video evidence of Iqbal proposing an illegal transaction.

         On March 16, 2011, Iqbal met with Saeger and Special Agent Linda Hanley, who was playing the undercover role of Linda Livesay, financial manager of PCP and the daughter of Cecil Livesay, the principal owner of PCP. Iqbal touted his strong relationship with physicians through his management company, reiterated the referral relationship that he had in mind, and said that he desired a fifty-fifty split of all profit PCP obtained from its services to the referred patients. Iqbal said that the arrangement would be on strong legal footing because PCP would not compensate the referring physicians. He also stated that he would compensate the physicians indirectly by discounting the services that he provided to the physicians through his management company.

         To mask the profit-splitting scheme, Iqbal suggested that the parties enter into a consulting agreement whereby Iqbal would purport to provide various services to PCP. Iqbal explained to Saeger and Hanley that he would send invoices to PCP for financial, marketing, and patient education services that he would purportedly perform, but that the invoice amount would always reflect fifty percent of the profits PCP earned from the patients that Iqbal would send to the company. Iqbal made clear that the purpose of these invoices was to ensure that any money exchanged between Iqbal and PCP had a valid paper trail so that the arrangement between the parties appeared legitimate.

         The parties eventually signed a consulting agreement with the terms that Iqbal had outlined in his meetings with Saeger and Hanley. At trial, Saeger testified that she understood that the consulting agreement was created to "cover the legalities of paying sums of money to Mr. Iqbal, " and that Iqbal would never actually perform any services for PCP. Iqbal never sent invoices to PCP or performed any services for the company.

         On April 14, Iqbal e-mailed to Saeger the medical records for a patient of Dr. Siddiqui, a doctor with whom Iqbal had an ongoing consulting relationship. A few days later, Saeger received another e-mail from Iqbal providing a prescription for home-health nursing care for the patient. PCP performed services for the patient and was reimbursed partly through Medicaid.

         Iqbal later arranged a meeting with Saeger and Hanley at Dr. Siddiqui's office to introduce them to the doctor. Iqbal said that PCP should communicate with Dr. Siddiqui's staff about any patient referred from Dr. Siddiqui's office, but Iqbal said that he would get involved and retrieve patient records if PCP believed that it was not getting the response it desired.

         In May, Iqbal sent Saeger an e-mail that provided the telephone number of a Dr. Bhutto. Iqbal explained that Dr. Bhutto had a patient in need of PCP's services and that Saeger should contact Dr. Bhutto regarding a referral. Saeger called Dr. Bhutto, and PCP later received the patient, provided services to her, and billed for reimbursement through Medicare. In an August meeting with Iqbal, Saeger explained that PCP could not provide additional therapy for Dr. Bhutto's patient because the doctor had not signed two ...

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