A California-based physician is suing the U.S. Department of Health & Human Services (HHS) and the U.S. Centers for Medicare & Medicaid Services (CMS) in response to fraud allegations that have resulted in licensure and billing privilege revocation.

Dr. Rami Moustafa Shaarawy recently filed a civil action lawsuit against HHS, CMS and Noridian Healthcare Solutions LLC, seeking to prevent termination of his physician billing privileges following Medicare fraud risk allegations presented by an independent contractor. Shaarawy provides internal and family medicine, palliative care and hospice services and operates a private practice in Canoga Park, California.

The North Dakota-based Noridian Healthcare Solutions raised fraud concerns alleging that

Shaarawy violated CMS regulations that stipulate that ​​a provider must disclose any and all affiliations made within the past five years that they have had with a currently or formerly enrolled Medicare, Medicaid or Children’s Health Insurance Program (CHIP) provider. The nonprofit contracted with CMS to act as the fiscal intermediary for the state of California. Shaarawy denies the allegations, citing misunderstandings made by Noridian.

“This is a civil action by Plaintiffs for a Temporary Restraining Order, Preliminary Injunction, and Permanent Injunction to prevent Defendants from putting Plaintiffs out of business and, thus, preventing Plaintiffs from providing essential medical services to thousands of elderly patients in California, based on a misunderstanding by Defendants and/or a misrepresentation by Valley Pacific Hospice Inc.,” court documents stated. “Defendants have notified Plaintiffs that they will revoke Plaintiffs’ Medicare enrollment and billing privileges, as well as place Plaintiffs on the CMS Preclusion List because of Defendants’ mistaken belief that there is an affiliation between Plaintiffs and Valley Pacific Hospice Inc.”

Shaarawy filed an injunction with the U.S. District Court for the Central Division of California to allow for continued Medicare licensure until the fraud dispute is resolved through the U.S. Centers for Medicare & Medicaid Services’ (CMS) appeals process. He is represented by attorneys Nicholas Jurkowitz and David Wagmeister from the firm Fenton Jurkowitz Law Group LLP.

Shaarawy denied allegations that he had any affiliation or managerial control with Valley Pacific Hospice, which according to the allegations posed “undue risk” of Medicare fraud, waste and abuse.

The fraud charges have led to difficulties in patients’ access to care, according to Shaarawy, who strived to “vigorously challenge the dispute” based on merits and information gained through CMS’ appeals and administrative reconsideration processes. Without the injunction granted, patients stand to lose both trust and care continuity, Shaarawy’s attorneys indicated in the court documents.

Failure to grant an injunction to prevent immediate revocation and preclusion without providing a prompt hearing violated Shaarawy’s procedural due process rights, attorneys allege.

“Absent intervention by this tribunal, Plaintiffs will suffer irreparable harm and will be forced out of business,” the Plaintiff’s attorneys indicated in court documents. “In addition, Plaintiffs’ many patients will lose their longstanding providers whom they know and trust. Without injunctive relief, Plaintiffs (and their patients) will be irreparably harmed before any meaningful opportunity to obtain the administrative review and judicial review to which they are entitled.”