United States v. Zia Iqbal
2017 U.S. App. LEXIS 16132
| 8th Cir. | 2017Background
- In March 2011 Zia Iqbal proposed to Patient Care Professionals (PCP) a scheme to refer Medicare/Medicaid patients to PCP in exchange for a 50/50 split of profits; he advised using a consulting agreement as cover.
- PCP administrator Millie Saeger alerted HHS-OIG; an undercover agent (posing as PCP financial manager) participated in recorded meetings with Iqbal.
- Iqbal transmitted patient records/prescriptions and introduced PCP to physicians (Dr. Siddiqui and Dr. Bhutto); PCP later provided services and received Medicaid/Medicare reimbursements.
- PCP gave Iqbal checks ($600 and $275) representing 50% of profits from services to two patients; no consulting invoices or services were actually performed.
- Federal agents searched Iqbal’s home; he denied referring or funneling patients in exchange for money. A grand jury charged him with several counts; after dismissal of health-care fraud counts, a bench trial resulted in convictions on three anti-kickback counts and one false-statement count; sentences were concurrent probation terms.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence that Iqbal solicited a kickback (Count Three) | Government: March 16 meeting showed Iqbal solicited a 50/50 profit split to induce referrals. | Iqbal: Insufficient proof he actually could cause or control referrals. | Affirmed — district court reasonably found solicitation to induce referrals. |
| Sufficiency of evidence that Iqbal received kickbacks (Counts Four & Five) | Government: emails, prescription transfer, introductions, and 50% checks show he induced referrals and received remuneration. | Iqbal: No evidence he exercised decision-making control over physicians’ referral choices. | Affirmed — court found reasonable inference that Iqbal induced those referrals and received payments. |
| False-statement conviction (18 U.S.C. §1001) | Government: Iqbal’s denials to agents were knowingly false because he had received kickback payments. | Iqbal: Contends false-statement conviction depends on overturning anti-kickback convictions. | Affirmed — because anti-kickback convictions were sustained, false-statement conviction stands. |
| Meaning of “refer” / whether causing or inducing referrals suffices (concurrence issue) | Government/district court standard assumed: soliciting/receiving remuneration in return for causing or inducing referrals violates statute. | Iqbal (and concurrence): “Refer” requires decision-making control over choice of provider; mere facilitation or introductions insufficient. | Majority: Iqbal waived challenge to statutory meaning; court assumed causing/inducing is sufficient and reviewed sufficiency accordingly. Concurrence: would have required decision-making control and would have reversed receipt convictions. |
Key Cases Cited
- United States v. Kain, 589 F.3d 945 (8th Cir. 2009) (standard for reviewing sufficiency of evidence after bench trial)
- United States v. Gentry, 555 F.3d 659 (8th Cir. 2009) (statutory-interpretation standard when sufficiency hinges on statute)
- U.S. Nat’l Bank of Or. v. Indep. Ins. Agents of Am., Inc., 508 U.S. 439 (1993) (courts may reach dispositive issues not raised by parties)
- United States v. Vernon, 723 F.3d 1234 (11th Cir. 2013) (interpreting “refer” to require practical decision-making control in related statutory context)
- United States v. Polin, 194 F.3d 863 (7th Cir. 1999) (finding referral where actor exercised choice over provider selection)
- United States v. Miles, 360 F.3d 472 (5th Cir. 2004) (no referral where actor only promoted services but did not control provider selection)