Document2 Mccutchueon QBR Qui Tam

Case 5:17-cv-00462-MHH Document 1 Filed 0 3 / 2 4 / 1 7 Page 7 of 51
performance and volume; reimbursement issues and various financial metrics
(related to revenue, expenses, and net income); and current issues (such as R O I f o r
equipment purchase, compliance issues, and client issues).
13. Throughout his six years as an owner o f QBR, Relator was the primary
liaison between Q B R and its outside b i l l i n g company, Defendant Derby Medical
Billing Services, Inc.
14. Derby Billing has handled billing services for Q B R since the company
began its operations.
15. Defendant Eric M . Beck is a physician, an owner o f Derby Billing, and
an owner o f Defendant Valley Center for Nerve Studies and Rehabilitation, Inc.
16. Relator worked closely with Janice Gardner to complete all private
insurance payer credentialing contracts in many states.
17. Relator and Gardner worked together to develop explanation o f benefits
processes, billing processes, and medical industry experience.
18. Relator has significant management and information technology
experience, as well as accounting and reporting experience.
19. Relator received and reviewed custom reports from Derby Billing on
behalf o f QBR. These reports detailed billed claims and reimbursed claims broken
down by client and individual physicians, general reimbursement information
broken down by referral source, and reports which consolidated billing and
False Claims Act Complaint |7

Case 5:17-cv-00462-MHH Document 1 Filed 0 3 / 2 4 / 1 7 Page 8 of 51
reimbursement information b y private and governmental insurance payers over time.
They were reliably and regularly used b y QBR.
20. As shown in this Complaint, Relator neither planned nor initiated any
o f the schemes alleged here. He was, however, responsible for the ongoing business
o f QBR and as such may provide reliable allegations regarding the schemes alleged
here because, in summary, Relator had access to all financial and billing information
(including specific insurance claim information, Q B R internal financial reporting
system, and reports from Derby Billing), client service information, vendor
contracting information, credentialing information, various other ancillary databases
and systems, and operational and strategic planning information for both QBR f o r
the entire time he served as V i c e President and CFO.
B. Defendants
21. Defendant QBR, L L C (QBR) is a corporation with its principal office
in Huntsville, Alabama at 303 Williams Avenue, Suite 311 Huntsville, Alabama
35801. It does business under the trade name ?Diagnostic Referral Community.?
QBR arranged and schedules healthcare staffing, logistics management,
telemedicine, and diagnostic equipment necessary to perform E M G , nerve
conduction, ultrasound and other diagnostic tests on-site at the offices o f various
healthcare providers. Q B R submitted, and continues to submit, claims for laboratory
services to Federal payors Medicare, Medicaid, and Tricare through the N P I number
False Claims Act Complaint |8

Case 5:17-cv-00462-MHH Document 1 Filed 0 3 / 2 4 / 1 7 P a g e 2 4 of 5 1
benefits generated b y marketing development and sales efforts

generated b y the Company.
MSA § 6.1(b).
TB. Q B R was responsible for engaging those referring physicians through
contracts c a l l e d Professional Services A g r e e m e n t s ( P S A ) . T h o s e contracts w e r e
made between Valley Nerve and the referring physician.
74. Those PSAs pay lip service to compliance with Federal law:
Valley shall render the technical portion o f the Tests and provide
certified technologist and other non-physicians as required b y the Tests;
provided, however, that the Provider Physician shall provide the
required level o f supervision o f such certified technicians as provided
in Section 2.2.
e X
Provider Physician agrees to provide the required level o f supervision

(whether General Supervision, Direct Supervision o r Personal
Supervision), administrative services, personnel, and space within
Provider Physician?s Office for the administration o f the Tests at
Provider Physician?s Office. Provider Physician understands that the
Tests cannot be administered by the certified technician without the
appropriate level o f supervision and Provider Physician agrees to work
in concert w i t h D R C ? Secure Telehealth and such supervision.
Notwithstanding the previous, Provider Physician understands and
agrees that the level o f supervision for any test may be altered in the
future and that Provider Physician agrees to provide the required
supervision i f altered b y any means, including b y medical association
recommendations, state regulations, Medicare o r Medicaid. Provider
Physician agrees to reasonably accommodate patient appointments
during the Normal Hours o f Operation and to not unreasonably restrict
or deny appointment times and days for patients and the certified
technician.
False Claims Act Complaint | 24

Case 5:17-cv-00462-MHH Document 1 Filed 0 3 / 2 4 / 1 7 P a g e 2 5 of 5 1
For all Physician Provider?s services described in this Agreement,

Valley shall pay to Physicain Provider the amount o f $. per Test,
which amount represents three total (3) hours o f Physician Provider?s
or its personnel?s time. The Parties acknowledge and agree that such
time is a reasonable estimate o f the amount o f time necessary to be
spent by Physician Provider in performing all o f the services to be
provided b y Physician Provider under this Agreement. The Parties
further acknowledge and agree that the payment is commercially
reasonable, constitutes fair market value for the services provided by
Physician Provider, that such payment has not been determined in a
manner that takes into account the volume o r value o f any referrals or
business otherwise generated between the Parties for which payment
may be made in whole o r in part under Medicare, Medicaid or other
Federal health care programs, and that such payment reasonably
reimburses Physician Provider for any and all costs, fees and expenses
incurred by Physician Provider in its performance of its services under
this Agreement.
PSA §§ 2.1(a), 2.2(a), 3.1(b)(i).
75. The reality o f those relationships was much different. In some
circumstances, the referring physician would enter only into a verbal agreement w i t h
QBR. In others, the referring physician would enter into the PSA.
76. Under a PSA, referring physicians were provided a negotiated rate o f
per-test remuneration. That rate was ostensibly set on a per-hour basis, but that was
an artifice. While the negotiated rates f o r those referring physicians ranged from $25
per hour to $100 per hour, those hourly rates were merely a pretext for per-test
kickbacks paid to the doctors.
77. Q B R created its o w n t i m e sheets, w h i c h established f o r m u l a s that set
predetermined time amounts spent to j u s t i f y the per-hour fee. These pre-created time
False Claims A c t Complaint | 25

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Case 5:17-cv-00462-MHH Document 1 Filed 0 3 / 2 4 / 1 7 Page 7 of 51

performance and volume; reimbursement issues and various financial metrics

equipment purchase, compliance issues, and client issues).

liaison between Q B R and its outside b i l l i n g company, Defendant Derby Medical

Billing Services, Inc.

began its operations.

15. Defendant Eric M . Beck is a physician, an owner o f Derby Billing, and

insurance payer credentialing contracts in many states.

17. Relator and Gardner worked together to develop explanation o f benefits

processes, billing processes, and medical industry experience.

18. Relator has significant management and information technology

experience, as well as accounting and reporting experience.

down by client and individual physicians, general reimbursement information

False Claims Act Complaint |7

reimbursement information b y private and governmental insurance payers over time.

They were reliably and regularly used b y QBR.

(including specific insurance claim information, Q B R internal financial reporting

contracting information, credentialing information, various other ancillary databases

the entire time he served as V i c e President and CFO.

21. Defendant QBR, L L C (QBR) is a corporation with its principal office

in Huntsville, Alabama at 303 Williams Avenue, Suite 311 Huntsville, Alabama

QBR arranged and schedules healthcare staffing, logistics management,

telemedicine, and diagnostic equipment necessary to perform E M G , nerve

healthcare providers. Q B R submitted, and continues to submit, claims for laboratory

False Claims Act Complaint |8

benefits generated b y marketing development and sales efforts

TB. Q B R was responsible for engaging those referring physicians through

contracts c a l l e d Professional Services A g r e e m e n t s ( P S A ) . T h o s e contracts w e r e

made between Valley Nerve and the referring physician.

Provider Physician agrees to provide the required level o f supervision

False Claims Act Complaint | 24

For all Physician Provider?s services described in this Agreement,

PSA §§ 2.1(a), 2.2(a), 3.1(b)(i).

75. The reality o f those relationships was much different. In some

76. Under a PSA, referring physicians were provided a negotiated rate o f

kickbacks paid to the doctors.

77. Q B R created its o w n t i m e sheets, w h i c h established f o r m u l a s that set

False Claims A c t Complaint | 25

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