United States v. Balance Diagnostics USA, LLC; Multi Mobile Imaging, Inc.; and Mount Sinai Doctors Riverside Medical Group, Southern District of New York (May 15, 2024) — Complaint

UNITED STATES DISTRICT COURT       
SOUTHERN DISTRICT OF NEW YORK 
 
 
 
 
 
 
15 Civ. 2641 (VSB) 
 
JURY TRIAL DEMANDED 
 
 
 
 
COMPLAINT-IN-INTERVENTION 
Plaintiff the United States of America (the “United States” or the “Government”), by 
and through its attorney, Damian Williams, United States Attorney for the Southern District 
of New York, brings this civil fraud action against Balance Diagnostics USA, LLC 
(“Balance” or “Defendant”) alleging as follows: 
UNITED STATES OF AMERICA, STATE OF NEW 
JERSEY, STATE OF NEW YORK, STATE OF 
ILLINOIS, CITY OF CHICAGO AND CITY OF NEW 
YORK ex rel. JANE DOE, 
 
                                      Plaintiffs, 
                    v. 
 
BALANCE DIAGNOSTICS USA, LLC, MULTI 
MOBILE IMAGING, INC., and MOUNT SINAI 
DOCTORS RIVERSIDE MEDICAL GROUP, 
 
                                       Defendants. 
UNITED STATES OF AMERICA, 
 
Plaintiff, 
                              v.  
 
BALANCE DIAGNOSTICS USA, LLC.  
 
Defendant. 

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PRELIMINARY STATEMENT 
1. This is  a civil fraud action brought by the United States against Balance under the 
False Claims Act, 31 U.S.C. §§ 3729-33 (the “FCA”), to recover treble damages sustained by, 
and penalties owed to, the United States as a result of the submission of false claims to Medicare 
and Medicaid.  The United States also seeks damages under the common law for unjust 
enrichment and payment by mistake.   
2. Balance is a diagnostic testing facility based in Cedarhurst, New York, which 
provides on-site mobile diagnostic testing services (“DTS”), such as video steganography (used 
to diagnose balance disorders) and ultrasound procedures.  
3. From January 2009 through December 2019, Balance offered and paid physicians 
and their practices hundreds of thousands of dollars in kickbacks in the form of sham rent 
payments to induce them to refer patients to Balance for DTS in violation of the Anti-Kickback 
Statute (the “AKS”), 42 U.S.C. § 1320a-7b(b).  Balance entered into sham office rental 
arrangements with over 100 physicians in the New York City area (the “Providers”), who 
referred thousands of patients to Balance for DTS that were reimbursed by Medicare and 
Medicaid. 
4. Balance’s scheme worked as follows.  Balance representatives reached out to 
physicians to inquire about “renting” space within their offices on certain days each month, 
where Balance would perform DTS on patients referred by these providers.  Balance typically 
would seek to use one exam room in the office and would send its staff to perform the tests on 
the referred patients.  
5. Unlike legitimate lease arrangements where rent amounts are based on the fair 
market value of the leased premises, Balance’s so-called rental arrangements with the Providers 
were based entirely upon the volume of patient referrals Balance received.  Specifically, Balance 

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representatives inquired about the volume of patients the Providers anticipated referring for DTS 
each month.  Balance and the Providers then used these anticipated referral rates to negotiate the 
amount Balance would pay in rent to the Providers each month.  Balance made no effort to 
determine whether any of these monthly payments were consistent with the fair market value of 
the leased space.  In many instances, the agreed-upon monthly payments were well above fair 
market value. 
6. After reaching an agreement on the monthly rent payments, Balance and the 
Providers typically entered into purported written lease agreements.  Many of these agreements, 
however, misrepresented key terms, such as the square footage of the rented space and the 
number of days per month Balance would use the space.  In some instances, Balance did not 
even enter into written lease agreements. 
7. Balance closely monitored the referral rates of the Providers to verify that the 
volume of patient referrals was consistent with what was discussed during negotiation of the rent 
amount.  If the monthly referral rates fell below the levels Balance expected, Balance frequently 
reduced the rent amount it paid to the Providers.  Balance representatives regularly contacted the 
Providers to pressure them to meet or exceed the expected referral rates.  In some instances, 
where referral rates were consistently below anticipated levels, Balance renegotiated the rent 
amounts downward or terminated the lease arrangements entirely. 
8. Balance characterized the payments to the Providers as rent payments because it 
knew that it was illegal to make payments in exchange for referrals and wanted to conceal the 
true purpose of the payments. 
9. Balance performed DTS on thousands of Medicare and Medicaid beneficiaries 
referred by physicians to whom Balance had paid illegal kickbacks in the form of rent payments.  

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Balance submitted, or caused other providers to submit, reimbursement claims to Medicare and 
Medicaid for these services.  Balance’s violations of the AKS rendered these claims false under 
the FCA.  As a    result, Medicare and Medicaid and/or their contractors paid substantial amounts 
for DTS to Balance and other providers that they were not entitled to receive. 
JURISDICTION AND VENUE 
10. This Court has jurisdiction over the claims brought under the FCA pursuant to 
31 U.S.C. § 3730(a) and 28 U.S.C. §§ 1331, and 1345, and over the common law claims 
pursuant to 28 U.S.C. § 1345. 
11. This Court may exercise personal jurisdiction over Balance pursuant to 31 U.S.C. 
§ 3732(a), which provides for nationwide service of process. 
12. Venue lies in the Southern District of New York pursuant to 31 U.S.C. § 3732(a) 
and 28 U.S.C. §§ 1391(b) and 1391(c), because Balance resides in this district, does business in 
this district, and Balance’s misconduct occurred in this district.   
PARTIES 
13. Plaintiff is  the United States of America suing on its own behalf and on behalf of 
the United States Department of Health and Human Services and its component agency, the 
Centers for Medicare and Medicaid Services, which administers and oversees the Medicare and 
Medicaid programs.  
14. Defendant Balance Diagnostics USA, LLC, is  a domestic limited liability 
company organized under the laws of the State of New York, with its principal place of business 
located in Cedarhurst, New York.  Balance is a diagnostic testing facility that provides DTS to 
patients in the New York City area, including in this district.  

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15. Relator is  a resident of New York.  On or about April 6, 2015, Relator filed a 
complaint under the qui tam provisions of the FCA and similar state false claims acts.  Relator 
subsequently filed an amended complaint and a second amended complaint. 
BACKGROUND 
I. Relevant Statutes 
A. The False Claims Act  
16. The FCA establishes civil penalties and treble damages liability to the United 
States for an individual who, or entity that, “knowingly presents, or causes to be presented, a 
false or fraudulent claim for payment or approval,” or “knowingly makes, uses, or causes to be 
made or used, a false record or statement material to a false or fraudulent claim.”  31 U.S.C. § 
3729(a)(1). 
17. “Knowingly” is defined to include actual knowledge, reckless disregard, and 
deliberate ignorance.  31 U.S.C. § 3729(b)(1).  No proof of specific intent to defraud is  required. 
Id. 
B. The Anti-Kickback Statute 
18. The AKS prohibits any person or entity from knowingly and willfully offering or 
paying any remuneration, directly or indirectly, overtly or covertly, in cash or in kind, to induce 
such person to, inter alia, “refer an individual to a person for the furnishing or arranging for the 
furnishing of any item or service for which payment may be made in whole or in part under a 
Federal health care program.”   42 U.S.C. § 1320a-7b(b)(2).  
19. The scienter element of the AKS is established by showing that “one purpose” of 
the remuneration at issue was to induce purchases or referrals, even if the remuneration also had 
other purposes that were legitimate.  United States v. Narco Freedom, Inc., 95 F. Supp. 3d 747, 

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759 (S.D.N.Y. 2015).  The AKS provides: “With respect to violations of this section, a person need 
not have actual knowledge of this section or specific intent to commit a violation of this section.”  
42 U.S.C. § 1320a-7b(h).  
20. Pursuant  to  the AKS, “a   claim  that  includes items  or services  resulting  from a 
violation  of [the  AKS]  constitutes  a false  or  fraudulent claim  for purposes  of [the  FCA].”    42 
U.S.C. § 1320a-7b(g).  Accordingly, a person violates the FCA when they knowingly submit or 
cause to be submitted claims to federal health care programs that result  from violations of the AKS. 
21. The  HHS  Office  of Inspector  General  has  promulgated “safe  harbor”  regulations 
that define practices that are not subject to the AKS because such practices are unlikely to result 
in fraud or abuse. 42 C.F.R. § 1001.952.  The safe harbors set forth specific conditions that, if met, 
assure persons involved of not being sanctioned for the arrangement qualifying for the safe harbor.  
However,  safe  harbor protection is  an  affirmative  defense that  is  afforded  to  only  those 
arrangements that meet all requirements of the safe harbor.   
22. Under the “space rental” safe harbor, a payment made to lease medical office space 
is  not remuneration  for  purposes  of  the AKS  only if  the rental  arrangement  satisfies  all     of the 
following six requirements: 
(1) The lease agreement is  set out in writing and signed by the parties. 
(2) The lease covers all    of the premises leased between the parties for the term of the 
lease and specifies the premises covered by the lease. 
(3) If the lease is intended to provide the lessee with access to the premises for 
periodic intervals of time, rather than on a full-time basis for the term of the lease, 
the lease specifies exactly the schedule of such intervals, their precise length, and 
the exact rent for such intervals. 
(4) The term of the lease is for not less than one year. 

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(5) The aggregate rental charge is set in advance, is  consistent with fair market value 
in arms-length transactions and is  not determined in a manner that takes into 
account the volume or value of any referrals or business otherwise generated 
between the parties for which payment may be made in whole or in part 
under Medicare, Medicaid, or other Federal health care programs. 
(6) The aggregate space rented does not exceed that which is  reasonably necessary to 
accomplish the commercially reasonable business purpose of the rental. 
42. C.F.R. § 1001.952(b).   
23. Pursuant to this safe harbor provision, the term “fair market value means the 
value of the rental property for general commercial purposes, but shall not be adjusted to reflect 
the additional value that one party (either the prospective lessee or lessor) would attribute to the 
property as a    result of its proximity or convenience to sources of referrals or business otherwise 
generated for which payment may be made in whole or in part under Medicare, Medicaid and all 
other Federal health care programs.” Id.      
II. Relevant Federal Health Care Programs 
24. Medicare is a federal program that provides subsidized health insurance primarily 
for persons who are 65 years of age or older or disabled.  See 42 U.S.C. § 1395 et seq.  Through 
Part B, Medicare covers reasonable and necessary outpatient medical services and care, 
including the types of diagnostic services and tests provided by Balance. 
25. Medicaid is  a joint federal and state program that provides healthcare benefits to 
certain groups, primarily the poor and those with disabilities.  42 U.S.C. § 1396 et seq.  Under 
Medicaid, each state establishes its own eligibility standards, benefit packages, payment rates, 
and program administration rules in accordance with certain federal statutory and regulatory 
requirements.  The state directly pays the healthcare providers for services rendered to Medicaid 
recipients, with the state obtaining the federal share of the Medicaid payment from accounts 
which draw on the United States Treasury.  See 42 C.F.R. § 430.0 et seq. 

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26. New York’s Medicaid program covers reasonable and necessary outpatient 
medical services and care, including the types of diagnostic services and tests provided by 
Balance.   
27. The federal portion of each state’s Medicaid payments, known as the Federal 
Medical Assistance Percentage, is  based on the state’s per capita income compared to the 
national average.  42 U.S.C. § 1396d(b).  Federal funding under Medicaid is  provided only when 
there is a corresponding state expenditure for a covered Medicaid service to a Medicaid 
recipient.  The federal government pays to the state the statutorily established share of the “total 
amount expended . . . as medical assistance under the State plan.”  42 U.S.C. § 1396b(a)(1). 
DEFENDANT’S FRAUDULENT SCHEME 
28. During the period from 2009 through 2019, Balance orchestrated a kickback 
scheme designed to direct patients to Balance for DTS reimbursable by Medicare and Medicaid.  
Specifically, Balance paid kickbacks to Providers in the form of sham rent payments to induce 
them to refer their patients to Balance for diagnostic tests and procedures. 
29. Balance routinely sent employees to visit physicians and medical practices—such 
as primary care—to persuade them to enter into these kickback arrangements.  Knowing these 
arrangements to be wrong, Balance sought to structure the payments as rent payments for office 
space used by Balance personnel to administer on-site DTS.  In actuality, the purpose of these 
payments was to induce referrals of patients to Balance for DTS.   
30. Balance’s agreements with the physician practices typically provided for the use 
of an exam room by Balance personnel, as well as for the use of basic equipment (e.g., a 
telephone, fax machine, a computer) and administrative staff to assist with patient flow and 
recordkeeping.  In exchange, Balance agreed to make a monthly rent payment, which could 
range from $1000 to several thousand dollars per month.  In many cases, the monthly payments 

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exceeded the fair market value for Balance’s limited use of the rented space, equipment, and 
services.  The sole factor Balance took into account when setting the monthly rent was the 
expected value of the patient referrals the Provider would generate. 
31. To ensure the monthly payments were generating the expected volume and value 
of patient referrals, Balance closely monitored patient referrals on a daily and monthly basis.  If 
referral rates fell below Balance’s expected levels, Balance employees reached out to the 
Providers and pressured them to increase patient referrals.  Balance also sometimes reduced the 
amount of its monthly payment, or made no monthly payments at all, based on low referral rates.  
Ultimately, Balance terminated certain lease agreements because of the continued low referral 
rate. 
32. From 2009 to 2019, Balance paid hundreds of thousands of dollars in rent to more 
than 100 Providers, who, in turn, referred thousands of patients to Balance for DTS.  A 
significant proportion of these referred patients were Medicare or Medicaid beneficiaries, and 
Balance billed Medicare or Medicaid for DTS administered on these beneficiaries. 
A. Balance Negotiated Sham Rent Amounts Based on Patient Referral Volume  
 
33. Balance routinely approached physician practices to solicit their involvement in 
the kickback scheme and negotiated the so-called rent payment based entirely upon the volume 
of patients the practice estimated it would be able to refer to Balance for DTS each month.  
Balance representatives typically asked about the number and type of DTS that the physician 
practice anticipated referring to Balance per day and/or per month.  Balance and the physician 
practice then negotiated the rent amount based on this information.   
34. The agreed-upon payment bore no relationship to the fair market value of the 
leased premises or factors affecting fair market value, such as the location, size, and quality of 

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the office space.  Indeed, Balance representatives made no effort to determine the fair market 
value of the leased premises.  
35. For example, in February 2015, Balance staff approached a physician practice 
(“Provider 1”) specializing in, among other things, oncology, hematology, and internal medicine, 
to discuss a patient referral arrangement.  Provider 1 had offices in Manhattan and the Bronx.   
Representatives of Balance and Provider 1 discussed the volume of DTS that Provider 1 
anticipated being able to refer to Balance.  Specifically, the representative of Provider 1 
estimated a patient volume of 10-15 per day.  The Balance representative asked, if  Provider 1 
referred 5-6 patients for DTS on one visit, would Provider 1 be able to refer 11-12 patients on the 
second visit.  The representative of Provider 1 responded affirmatively and stated,  “I know how 
to push it if I have to .” 
36. In March 2015, Balance representatives likewise reached out to a physician 
family practice in Purchase, New York (“Provider 2”), to discuss the referring of patients to 
Balance for DTS.  A Balance representative asked a representative of Provider 2 how many 
diagnostic tests Provider 2 could refer to Balance.  The representative of Provider 2 proposed 
referring 6 – 7 diagnostic tests each day Balance sent staff to the office.  The Balance 
representative responded that he wanted 12-15 tests.  Balance and Provider 2 ultimately agreed 
that Balance staff would go to Provider 2’s office twice a month, and the purported monthly rent 
payment would be $1300 (or $650 per visit). 
B.  Balance and the Providers Entered Into Sham Lease Agreements 
37. After agreeing upon a monthly rent amount based upon the anticipated patient 
referral rate, Balance and the Providers frequently executed written lease agreements to make it 
appear as though the parties were entering into legitimate office rental arrangements.  In other 

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instances, Balance and the Provider proceeded without even bothering to execute a written 
agreement. 
38. When written lease agreements were prepared, the terms specified in the leases 
often did not reflect the actual terms of the arrangement.  Balance’s written lease agreements 
with Providers frequently used identical stock language to describe the office space and access to 
the space, regardless of the actual arrangement or leased premises.  For example, many of the 
written lease agreements state that Balance rented 750 square feet and that Balance would use 
the office space seven days per week as needed, even though the actual square footage 
significantly differed from 750 square feet and Balance staff used the space only a handful of 
days each month. 
39. The reason that certain terms of Balance’s lease agreements—other than the 
monthly rent amounts—were largely identical and often did not reflect the actual square footage 
or frequency of use is that the lease agreements were shams, intended to make it appear as 
though Balance’s monthly kickbacks were legitimate rent payments that complied with the AKS, 
when that was not the case.  In reality, Balance made payments to the Providers based solely on 
the volume of patients they referred to Balance for DTS.  Balance structured and characterized 
the stream of payments to the Providers as rent payments for the use of office space because it 
understood that paying physicians for patient referrals was illegal.   Because lease terms such as 
square footage had no bearing on the agreed-upon monthly kickback amounts, it made little 
difference to Balance whether the written lease agreements stated the terms accurately.   
C. Balance Pressured Providers to Meet Anticipated Referral Rates and 
Reduced or Terminated Monthly Payments for Low Referral Volume 
 
40. Balance prepared Records detailing the number of patients and types of DTS that 
the Providers referred to Balance each month and closely monitored this data to determine 

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whether they were consistent with the anticipated referral rates that Balance and the Providers 
had discussed when agreeing upon the monthly rent amount.   
41. If a Provider’s referral rate was lower than anticipated, Balance representatives 
reached out and pressured the Provider to increase the number of patient referrals.  In addition, 
Balance unilaterally reduced the amount of monthly payments to Providers, or made no monthly 
payments at all, based solely on lower-than-expected referral rates.  In some instances, Balance 
terminated its agreements with Providers due to low referral volume. 
42. For example, Balance monitored the number and type of DTS that Provider 1 
referred to Balance each month and repeatedly encouraged Provider 1 to increase its referrals 
when the referral volume was less than Balance had anticipated. 
43. In October 2015, when Balance did not receive the expected volume of referrals 
from Provider 1, a Balance principal told a Balance employee that Provider 1 had to get its 
numbers up.   
44. In March 2016, the Balance principal and employee discussed the referral 
numbers with a representative of Provider 1.  During this discussion, the Balance principal stated 
that “we can’t go up and down” in referrals, that  “in almost every one of the offices that we 
service, we for sure see 10 [referrals].”  The Balance principal further stated that “if I keep on 
seeing a trend, if I see it is working out for us, the relationship will keep on going,” but “[i]f I see 
that it is not worth it to us, I’m just going to tell you.”  The Balance principal also advised the 
Provider 1 representative that certain diagnostic tests did not count as referrals because of the 
low reimbursement rate that Balance would receive from insurance.   
45. Balance representatives continued to pressure Provider 1 to meet Balance’s 
expected referral rates.  On multiple occasions in 2016, Balance made reduced monthly 

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payments, or made no monthly payments at all, to Provider 1 because Provider 1 did not refer as 
many patients as Balance had expected.  Balance’s pressure to increase referrals continued until 
Balance terminated the sham rental arrangement with Provider 1 in late 2016. 
46. Balance likewise closely monitored Provider 2’s patient referral rates.  In May 
2015, a Balance representative had a discussion with a representative of Provider 2 about the 
insufficient volume of referrals.  The Balance representative noted that Provider 2 had referred 
only 7 ultrasound tests to Balance when staff were at  the office on May 11, 2015.  The Balance 
representative further stated that, in order for the agreed-upon $650/visit rate to work for 
Balance, Provider 1 would need to make more than 7 referrals per visit.  The representative of 
Provider 2 responded that this was possible.  
47. In June 2015, a Balance principal and an employee discussed Balance’s upcoming 
monthly payment to Provider 2.  The Balance employee had prepared two checks for Provider 
2—one check for the full rent amount of $1,300, and a second check for half of that amount, or 
$650—and asked which check Balance should provide.  The Balance principal reviewed the 
number of referrals from Provider 2 over the previous months and explained that Balance wanted 
an average of close to 15 referrals per visit for a $650 per visit rate.  Concluding from this review 
and discussion that the volume of Provider 2’s prior referrals had been insufficient, Balance 
decided to give Provider 2 the check for half the monthly amount.  In the following months, 
Balance’s monthly payments to Provider 2 continued to vary in amount depending on the 
number of patients referrals from Provider 2. 
48. Balance varied its monthly payments to dozens of other Providers based solely on 
patient referral volume.  For example, during 2012 through 2016, Balance had a lease agreement 
with a physician practice located in Yonkers, New York, specializing in, among other things, 

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primary care and internal medicine (“Provider 3”).  Pursuant to its agreement with Provider 3, 
Balance initially agreed to make monthly payments of $5,000.  However, Balance repeatedly 
changed the amount of the monthly payment paid to Provider 3 based on referral volume despite 
the rent amount specified in the lease.  In 2015, the rent amount was changed to $1,500 per 
month. Eventually, after several months during which the number of referrals was lower than 
Balance expected, Balance unilaterally lowered the amount of the monthly payment to $500. 
49. Likewise, during 2012, Balance had a lease agreement with a physician practice 
specializing in internal medicine located in Elmhurst, New York (“Provider 4 “).  Under the 
agreement, Balance agreed to make monthly payments of $1,200 to Provider 4.  Balance 
representatives told a representative of Provider 4 that Balance expected to receive 
approximately 10 referrals each day Balance staff were at the office to justify the monthly 
payment amount.  After the first month of the arrangement, Balance paid Provider 4 less than the 
agreed-upon monthly payment amount, or made no monthly payments at all.  When an employee 
of Provider 4 telephoned Balance to inquire about the reduced or absent monthly payments, a 
Balance representative advised that Balance paid less rent, or no rent at  all, when the referral 
rates for diagnostic tests were lower than Balance expected.  
50. Balance made no meaningful attempt to determine whether any of the purported 
rent payments it made to Providers were consistent with the leased premises’ actual fair market 
value.  In many instances, the purported rent payments significantly exceeded fair market value.  
* * * * * 
51. The AKS provides a safe harbor for legitimate office rental agreements.  
However, to qualify for the relevant safe harbor, the rental fees must be set in advance, 
consistent with fair market value, and not be determined in a manner that takes into account the 

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volume of any referrals, and the lease must be commercially reasonable in the absence of 
referrals.   
52. Here, because Balance’s payments to Providers were actually kickbacks 
structured as rent payments, they failed to meet any of these criteria.  As described above, though 
agreements typically set a monthly rental fee, Balance reduced or skipped monthly payments to a 
Provider when the value of referrals dipped, without regard to the rent purportedly due.  In many 
cases, Balance’s payments were significantly in excess of fair market value.  And the lease 
agreements were not commercially reasonable in the absence of referrals; indeed, when the value 
of referrals from a Provider continued to fall below Balance’s expectations, Balance terminated 
the arrangement. 
53. The Providers referred thousands of Medicare and Medicaid beneficiaries to 
Balance for DTS.  After the DTS were administered, other medical providers (the “Readers”) 
read and interpreted the results.  Sometimes the Reader was one of the Providers who had 
kickback arrangements with Balance.  Both Balance and the Readers submitted reimbursement 
claims to Medicare and Medicaid for the diagnostic test and procedures. 
54. Accordingly, Balance submitted, and caused the Readers to submit, claims for 
payment to Medicare and Medicaid for services resulting from the unlawful payments made to 
the Providers.  Because these claims were tainted by Balance’s kickbacks, they constituted false 
claims under the FCA.  Consequently, Balance wrongfully received, and caused the Readers 
wrongfully to receive funds from Medicare and Medicaid to which they were not entitled. 

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CLAIMS FOR RELIEF 
COUNT ONE: PRESENTING FALSE CLAIMS FOR PAYMENT  
VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C. § 3729(a)(1)(A) 
55. The Government incorporates by reference each of the preceding paragraphs as if  
fully set forth herein.  
56. The Government seeks relief against Balance under 31 U.S.C. § 3729(a)(1)(A). 
57. Through the acts set forth above, Balance, acting with actual knowledge or with 
deliberate ignorance or reckless disregard of the truth, presented, or caused to be presented, false 
or fraudulent claims for payment or approval to the government when requesting reimbursements 
for services or procedures.  Specifically, Balance presented or caused to be presented false 
claims for payment to the government for DTS that were the result of patient referrals by 
physicians to whom Defendant had paid kickbacks in violation of the AKS. 
58. By reason of the false or fraudulent claims, the United States has sustained 
damages in a substantial amount to be determined at trial and is  entitled to treble damages plus a 
civil penalty for each violation. 
COUNT TWO: USE OF FALSE STATEMENTS  
VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C. § 3729(a)(1)(B) 
59. The Government incorporates by reference each of the preceding paragraphs as if  
fully set forth herein.  
60. The Government seeks relief against Balance under 31 U.S.C. § 3729(a)(1)(B). 
61. Through the acts set forth above, Balance knowingly made, used, or caused to be 
made and used, false records and statements material to the payment of false or fraudulent claims 
for payment for DTS performed on Medicare and Medicaid beneficiaries.  These false records 
and statements included but are not limited to false certifications that the claims complied with 

17 
applicable laws, regulations, and program instructions for payment and were true, accurate, and 
complete. 
62. These false records and statements were material to the false or fraudulent claims 
because Medicare and Medicaid would not have paid the claims absent the records and 
statements. 
63. Balance made, used, or caused to made and used, these false records and 
statements with actual knowledge of their falsity, or indeliberate ignorance or reckless disregard 
of whether or not they were false. 
64. By reason of these false records and statements, the Government has sustained 
damages in a substantial amount to be determined at tr ial  and is  entitled to treble damages plus a 
civil penalty for each violation. 
COUNT THREE: UNJUST ENRICHMENT 
65. The Government incorporates by reference each of the preceding paragraphs as if  
fully set forth herein. 
66. Through the acts set forth above, Balance has received Medicare and Medicaid 
reimbursements to which it was not entitled and therefore has been unjustly enriched.  The 
circumstances of these payments are such that, in equity and good conscience, Balance should 
not retain those payments, the amount of which are to be determined at trial. 
COUNT FOUR: PAYMENT UNDER MISTAKE OF FACT 
67. The Government incorporates by reference each of the preceding paragraphs as if  
fully set forth herein. 
68. The Government seeks relief against Balance to recover monies paid under 
mistake of fact. 

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69. The Government paid Balance for claims submitted to Medicare and Medicaid 
based on the mistaken and erroneous belief that the claims were not the result of patient referrals 
by physicians to whom Balance had paid kickbacks in violation of the AKS.  If the Government 
had known that the claims were the result of patient referrals by physicians to whom Balance had 
paid kickbacks in violation of the AKS, it would not have paid the claims.  In such 
circumstances, the payments by Medicare and Medicaid to Balance were by mistake and were 
not authorized. 
70. Because of these payments by mistake, Balance received monies to which it  is  not 
entitled. 
71. By reason of the foregoing, the Government was damaged in a substantial  amount 
to be determined at  trial. 
PRAYER FOR RELIEF 
72. WHEREFORE, the Government respectfully requests judgment to be entered in 
its favor as follows:    
(i) On Counts One and Two (FCA violations), a judgment against Balance for 
treble damages and civil penalties to the maximum extent allowed by law; 
 
(ii) On Counts Three and Four (Unjust Enrichment and Payment Under 
Mistake of Fact), a judgment against Balance for damages to the 
maximum extent allowed by law; and  
 
(iii) A judgment against Balance for costs and such other relief as the Court 
may deem appropriate. 
 

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Dated:  May 10, 2024  
New York, New York     
 
DAMIAN WILLIAMS 
United States Attorney for the 
Southern District of New York 
 
/s/  Pierre G. Armand             
PIERRE G. ARMAND 
Assistant United States Attorney 
86 Chambers Street, Third Floor  
New York, New York 10007 
Tel.:     (212) 637-2724 
Email: [email protected] 
Counsel for the United States