Delaware doctor who ordered tests for people she didn’t examine to pay feds $180,000

What are journalists missing from the state of Delaware? What would you most like WHYY News to cover? Let us know.

A Delaware doctor who ordered medically unnecessary genetic cancer tests for 103 people she never examined has agreed to pay the federal government $180,000 to resolve claims that her illegal actions cost Medicare $565,000.

Dr. Shayasta S. Mufti’s alleged civil violations of the False Claims Act occurred during a seven-month period in 2019 and were outlined in the complaint filed in June by the U.S. Attorney’s Office in Delaware.

Mufti has not been charged criminally, but the U.S. District Court complaint and the April settlement that included an “undisputed” statement of facts detail how she went afoul of the law by ordering tests that were “not reasonable and necessary, and not covered by Medicare,” court records show.

Working as a consultant for the telemedicine company MySpecialistMD, Mufti was paid $25 for each “purported consultation,” the complaint said, and with other fees received a total of $15,000 from MySpecialistMD.

Her phony exams led to $1.7 million in bills being sent to Medicare, the complaint said. Medicare actually paid $565,000, the settlement said.

Mufti ordered the tests, even though as an enrolled provider in Medicare, the government’s health program for older Americans and some people with disabilities, she had agreed to comply with program laws, regulations and program instructions.

That meant she would “not knowingly present or cause to be presented a false or fraudulent claim for payment by Medicare, and will not submit claims with deliberate ignorance or reckless disregard of their truth or falsity,” the complaint said.

Instead, that’s exactly what she did, prosecutors wrote, alleging that Mufti only had “brief, if any” communications with the 103 people, but “electronically approved” the genetic tests through an online portal.

“Dr. Mufti had no pre-existing physician-patient relationship with any of the beneficiaries for whom she ordered testing. Notwithstanding her certifications, she did not examine the beneficiaries, and made no effort to determine whether genetic testing was medically necessary or consistent with Medicare coverage limitation,” according to the statement of facts.

“Dr. Mufti did not review or discuss the test results with the beneficiaries, and she did not use the results of the genetic tests to manage their medical conditions or inform any treatment decisions. Her determinations were based solely on the criteria supplied by MySpecialistMD, not on any medical judgment consistent with Medicare requirements.”

Mufti, who has an active medical license in Delaware, could not be reached. Her attorney, Adam Balick, had no comment.

Benjamin Wallace, Delaware’s U.S. attorney, would not agree to an interview but had harsh words about Mufti’s actions in a written statement.

“Physicians who order unnecessary and expensive services, including genetic tests, drain critical resources from Medicare and other federal health care programs,” Wallace said. “These schemes not only waste taxpayer dollars, they undermine the integrity of programs that millions of Americans rely on.”

Three-quarters of the genetic tests that Mufti ordered were done by Landmark Diagnostics, a laboratory based in Houston.

In 2022, Landmark owner Daniel Hurt pleaded guilty in federal court to health care fraud, taking kickbacks and money laundering in Pennsylvania, New Jersey and Florida. Hurt is now serving a 10-year prison sentence for orchestrating the scheme that ripped off Medicare and other insurers of tens of millions of dollars for bogus genetic testing for cancer.

‘Patient would like to be informed of any further risk’

The complaint had highlighted a handful of her cases, including a 57-year-old woman who lived in Louisiana — 1,300 miles from Delaware.

Mufti never treated, examined, met or even communicated with the woman, the complaint said. She did try to reach the woman by phone for a telehealth consult, calling three times, only to learn it was the wrong number.

That failure to connect didn’t stop Mufti from ordering a comprehensive battery of genetic tests to help determine the woman’s risk of contracting cancer, the complaint said.

The rationale for the expensive testing, according to Mufti’s “physician encounter note,” was that the woman’s sister and grandmother had breast cancer.

“Hence, patient would like to be informed of any further risk(s) to themselves and/or family members by understanding their genetic composition,” the certificate of medical consultation electronically signed by Mufti said.

The tests were done and Medicare reimbursed the lab $4,980. But Mufti never reviewed the test results or followed up with the woman, the complaint said.

Mufti took similar actions with a 71-year-old woman who lived in western Pennsylvania, the complaint said.

Mufti attested that she had performed a medical consultation, the woman was her patient, the genetic testing was needed to assess her disease risks, and results would be used “to determine the patient’s medical management and treatment decision,” the complaint said.

Mufti had no idea, however, if the woman “would even be provided with the results of the genetic testing,” the complaint said.

That didn’t matter, the complaint said, because the goal with each of the 103 people was not to treat the men or women but to bamboozle the federal government.

“Medicare would not and could not have paid these claims,” the complaint said, “if it had known the truth.”