Submitted: January 13, 2017
from United States District Court for the Eastern District of
Missouri - St. Louis
COLLOTON, GRUENDER, and KELLY, Circuit Judges.
COLLOTON, Circuit Judge.
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 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.
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
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.
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.
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
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.
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
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.
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 ...