# Scarbrough

> District Court, N.D. Alabama · January 27, 2026

URL: https://www.frixlaw.com/law-library/cases/11246836

## Case

- **Full name:** United States of America ex rel. Dr. Todd Scarbrough v. Alabama Cancer Care, LLC, et al.
- **Court:** District Court, N.D. Alabama
- **Decided:** January 27, 2026
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/11246836

## How later opinions describe it (automated extraction)

- affirming dismissal of complaint that discussed in detail a handful of patients’ lab results but that offered no factual basis for conclusory allegation that the defendant billed claims related to those lab results to the Government

## Opinion text

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
EASTERN DIVISION

UNITED STATES OF AMERICA
ex rel. DR. TODD SCARBROUGH,
Plaintiff,

v. Case No. 1:22-cv-1533-CLM

ALABAMA CANCER CARE, LLC,
et al.,
Defendants.

MEMORANDUM OPINION
On behalf of himself and the United States, Dr. Todd Scarbrough sues
his former employer, Alabama Cancer Care, LLC, as well as Dr. Shelby
Sanford and Dr. Ashvini Sengar, asserting that they knowingly defrauded the
United States by billing Medicare for radiation oncology services that were
never performed or medically unnecessary. The court dismissed some of the
claims in Scarbrough’s original complaint without prejudice to give Scarbrough
the opportunity to correct any deficiencies (docs. 34, 35). Scarbrough has since
amended his complaint (doc. 41), and Defendants move to dismiss the amended
complaint (doc. 44). The court rules on Defendants’ motion here.
This opinion should be read as a continuation of the court’s opinion about
the original complaint (doc. 34), which the court calls “Part I” from now on. For
the reasons stated below, Part II ends with the same result: The court
GRANTS IN PART and DENIES IN PART Defendants’ motion to dismiss
(doc. 44).
BACKGROUND
Scarbrough bases his amended complaint on the same essential facts as
his original complaint, so the court needn’t repeat all Scarbrough's allegations
here. The court instead limits its recitation of the facts to (a) allegations
Scarbough added in his amended complaint, and (b) allegations relevant to
Defendants’ motion to dismiss that weren’t the focus of Part I of this opinion.
Scarbrough’s amended complaint asserts that Alabama Cancer Care
(“ACC”) participated in three schemes to defraud Medicare:
• Billing for radiation treatment management under CPT Code
77427 that was never provided.
• Billing for computed tomography (CT) diagnostic services that
were never reviewed by a physician as required by Medicare
conditions of payment and forging and falsifying documentation to
substantiate billing for such services.
• Billing for IMRT services, performed using equipment that was
unsafe and not properly verified as safe and effective under
Medicare’s requirements.
(Doc. 41, ¶ 9, 41).
A. Claims for Radiation Treatment Management (Code 77427)
Scarbrough first says ACC improperly billed Medicare for radiation
treatment management under CPT Code 77427, which Scarbough says
requires a radiation oncologist to personally visit the patient once every five
fractions. (Id., ¶¶ 46–48). As discussed in Part I, Scarbrough asserts that Dr.
Sanford submitted false claims under CPT Code 77427 because Sanford “never
sees the patients,” which “has always been [Sanford’s] practice.” (See id., ¶ 56).
1. Sengar: Scarbrough contends that Dr. Sengar falsely billed Medicare
under CPT Code 77427 for two reasons. First, Scarbrough asserts that he
learned from ACC’s Anniston office medical assistant Shelby Brodeur that
Sengar instructed Anniston billing employees to bill Medicare under Code
77427 even though Sengar did not see patients as required to bill under that
code. (Id., ¶ 67). Second, Scarbrough says Sengar billing for radiation
treatment management services is facially fraudulent because Sengar is not a
radiation oncologist. (Id., ¶ 68). To support this assertion, Scarbrough points
out that while Sengar is board certified by the American Board of Internal
Medicine, he is not board certified by the American Board of Radiology in
radiation oncology. (See id., ¶ 72). Scarbrough also notes that after graduating
from medical school, Sengar did an internal medicine residency for three years
followed by a three-year medical oncology fellowship. (Id., ¶ 71).
2. Sehbai: Scarbrough’s final radiation treatment management-related
allegations are that ACC submitted false claims under Code 77427 on behalf
of Dr. Aasim Sehbai. According to Scarbrough, Sehbai, like Sengar, instructed
Anniston billing employees to bill Medicare under Code 77427 even though he
did not see patients as required to bill under that code. (Id., ¶ 67).
B. Claims for CT Diagnostic Services (Code 77014)
CPT Code 77014 corresponds with review of radiation oncology CT scans
and is called “CT Guidance for placement of radiation therapy fields.” (Id., ¶
93). As explained in Part I, Scarbrough alleges that ACC routinely improperly
accessed his electronic medical records (“EMR”) account and NPI number to
bill for thousands of services under CPT Code 77014 as though Scarbrough
personally performed the services—which he didn’t. (Id., ¶ 109). Scarbrough
also says that he learned that the ACC employees who fraudulently signed
treatment records under his name never signed the images or records before
the next fraction. (See id., ¶ 113). Thus, Scarbrough contends that claims for
these CT scan diagnostic images were fraudulent for two reasons. First, the
diagnostic images weren’t reviewed by a physician. (Id., ¶ 114). Second, the
images were medically unnecessary because they weren’t reviewed by anyone
until after the radiation treatment that was purportedly informed by the CT
image was already performed. (Id.).
Scarbrough also asserts that he wasn’t the only doctor whose NPI
number was improperly used to submit claims under Code 77014. For example,
Scarbrough alleges that ACC also used Dr. Anna Harris’s NPI number to
submit false claims under Code 77014. (Id., ¶ 122). Scarbrough has reviewed
medical records of CT images purportedly signed by Harris and recognized that
the images weren’t in fact reviewed by Harris and were signed weeks or
months after the image and radiation therapy supposedly based on that image
was completed. (See id.). J.W. is one Medicare patient whose medical records
Scarbrough reviewed. (Id., ¶ 123). J.W. received two IGRT treatments per day,
five days a week from May 17, 2022, to May 31, 2022. (Id.). Before each of these
treatments, J.W. received a CBCT image that should have been performed to
accurately position the radiation to J.W.’s cancerous tissue. (Id.). Each of these
CBCT images were then billed to Medicare under Harris’s NPI number (Id.).
Scarbough, however, asserts that Harris had no idea that ACC was
billing Medicare for these CBCT images and did not sign the image as required
to bill for this service. (Id.). Instead, one of the radiation technicians in the
Anniston Office signed these images under Harris’s name within ACC’s EMR
system. (Id.). Plus, the forged signatures on J.W.’s CBCT images weren’t
executed until weeks after the service was performed. (Id.). For example, the
CBCT image performed on May 17, 2022, was not signed until May 31, 2022,
rendering any review or adjustment of radiation based on this image
meaningless and medically unnecessary. (Id.).
C. Claims for IMRT (Codes 77301, 77338, G6015, G6016)
1. IMRT requirements: Scarbrough finally alleges that ACC does not
perform the reasonable and necessary quality assurance required for intensity
modulated radiation (“IMRT”) services. IMRT is a highly specialized form of
radiation therapy that involves a computer-based method of planning for, and
delivery of, narrow patient specific modulated beams of radiation to solid
tumors within a patient. (Id., ¶ 125). With IMRT, exacting Quality Assurance
(“QA”) is necessary to achieve the preferred radiation dose distribution with
accuracy and reproducibility. (Id., ¶ 130). Thus, patient specific QA is expected
to be performed to receive Medicare reimbursement for IMRT services. (Id.).
A critical component to the required patient specific QA process is “Dose
Delivery Verification.” (Id., ¶ 139). For this process, a qualified medical
physicist should ensure verification of the radiation doses being received
during treatment. (Id.). Before the start of each patient’s course of treatment,
accuracy of dose delivery should be documented delivering a test dose of
radiation to a phantom. (Id.). A phantom is a mass of material used to mimic
human tissue and contains a calibrated dosimetry system to verify that the
dose delivered is the dose planned. (Id., ¶ 140). So the required patient specific
QA for IMRT typically involves performing the planned radiation dose delivery
for each patient before beginning the course of treatment. (Id., ¶ 141). This
testing procedure is called “patient-specific end-to-end testing,” and either this
test or an alternative test that provides equivalent verification is required for
safe and effective IMRT delivery. (Id., ¶¶ 141–42).
Medicare pays only for services that are generally accepted in the
medical community as safe and effective. (Id., ¶ 26). And Scarbrough says that
performing IMRT without performing patient specific end-to-end testing QA
using a phantom or equivalent is not generally accepted in the medical
community as safe and effective. (Id., ¶ 144). For example, the American
College of Radiology and American Society for Radiation Oncology note that
patient-specific QA is an industry standard for IMRT services:
Patient-specific QA must be performed before clinical
treatment begins. Further, QA procedures are then continued
through the IMRT treatment process. Such patient-specific
treatment verification is linked to implementation; it may
be considered the confirmatory phase of the IMRT treatment
process, assuring compliance with the aforementioned
sections for the individual patient. Through a process that
starts before the initiation of treatment and then continues
throughout the course of treatment, verification data confirm the
correctness of the administered dose using transfer of both the
technical setup and the dose delivery data. The radiation
oncologist must remain available to adjust, modify, and revise any
aspects of the initial plan as the clinical situation warrants. . . The
medical physicist should assure verification of actual radiation
doses being received during treatment delivery. Before the start of
treatment and using all of the parameters of the patient’s
treatment plan, the accuracy of dose delivery should be
documented by irradiating a phantom containing a
calibrated dosimetry system to verify that the dose delivered
is the dose planned. Multiple points in the delivered distribution
should be compared against the planned distribution, as can be
accomplished, for example, using film dosimetry with the
phantom. This testing procedure has been termed “patient-
specific end-to-end testing.”
(Id., ¶ 145 (emphasis in original)).
And in December 2023, Medicare established Local Coverage
Determination (“LCD”) L39553. (Id., ¶ 146). According to Scarbrough, this
LCD adopted the decades old industry standards on patient-specific QA:
The physicist or supervised dosimetrist will calculate a multiple
static beam and/or modulated arc treatment plan to deliver the
prescribed radiation doses to the PTV and also meet OAR dose
constraints. Dose volume histograms must be prepared for the
PTV and OARs. Continuously moving MLCs are used to deliver
the optimized modulated radiation doses to the tumor and nearby
organs with that patient. The distinguishing feature of an
IMRT plan is that it demonstrates how treatment with non-
uniform beam intensities will be delivered. Basic dose
calculations are done on each of the modulated beams or arcs in
order to verify the computerized calculations. The calculated
beams or arcs are delivered to a phantom or a dosimetry
measuring device to confirm the intended dose will be
accurate and that delivery will be technically feasible.
(Id., ¶¶ 146–47(emphasis in original and footnotes omitted)).
Scarbrough says that under these industry recognized standards
Medicare has conditioned payment for IMRT services on providers performing
verification of radiation therapy in either a phantom or through a dosimetry
measuring device to confirm that the intended dose will be accurate and that
delivery will be technically feasible. (Id., ¶ 148).
2. ACC’s procedures: Scarbrough alleges that in January 2016 all ACC
clinics changed their QA verification process to remove required patient
specific QA procedures. (Id., ¶ 152). Sanford and Keith Mills, ACC’s physicist,
made this decision to cut costs and increase revenue. (Id., ¶ 152–53). This new
QA process does not involve verifying the radiation delivery machines via
phantoms or a calibrated dosimetry measuring device. (Id., ¶ 155). Instead,
RadCalc software uses a virtual phantom and only checks the physical
measurements of the radiation machine quarterly. (Id., ¶ 156).
Scarbrough says that ACC’s use of a virtual phantom is deficient because
this generic phantom is not based on any specific patient or patient’s custom
designed treatment plan. (Id., ¶ 159). Thus, Scarbrough asserts that the
RadCalc software does not (1) verify that the calculated beams or arcs are
delivered to a phantom or dosimetry measuring device, or (2) confirm that the
intended dose will be accurate and feasible in accordance with the patient’s
specific treatment plan. (Id., ¶ 158).
In April 2017, Scarbrough questioned Mills about the lack of patient-
specific IMRT QA procedures. (Id., ¶ 165). Scarbrough copied Sanford and
Sengar on this email exchange and informed them that ACC’s QA process was
deficient and in violation of Medicare Conditions of Payment. (Id.). In response,
Mills acknowledged that ACC’s current procedures did not assess the physical
characteristics of the radiation machine or the specific patient set-up and
positioning. (Id., ¶ 167). Instead, Mills stated that he performs verifications on
a standard phantom within the software RadCalc. (Id.). Scarbrough says that
there are at least three problems with this response. First, a standard phantom
is not equivalent to the patient specific requirements because not all patients
are the same and patients receive radiation therapy for different organs that
impact different organ systems. (Id., ¶ 168). Second, RadCalc does not use a
calibrated dosimetry measuring device, so it does not perform dose verification
using a physical phantom or calibrated dosimetry measuring device per
established industry standards. (Id., ¶ 169). Finally, performing only software
verifications is not equivalent to true patient specific phantom QA because the
software cannot verify that the machine is functioning properly and that the
specific patient is set up and stabilized to properly receive safe and effective
radiation treatment. (Id., ¶ 170).
Because ACC removed patient specific IMRT QA procedures at all ACC
facilities in January 2016, Scarbrough says that each ACC claim submitted
after January 2016 for CPT Codes 77301, 77338, G6015, and G6016 (i.e., the
IMRT CPT Codes) was false. (Id., ¶ 174).
D. The Complaint
Scarbrough’s amended complaint pleads four counts against ACC,
Sanford, and Sengar. Count 1 alleges that ACC violated 31 U.S.C.
§ 3729(a)(1)(A) by presenting or causing to be presented false claims for each
of the three alleged schemes. (Id., ¶¶ 195–99). Count 2 alleges that Sanford
violated 31 U.S.C. § 3729(a)(1)(A) by submitting or causing to be submitted
false claims for radiation treatment management services under CPT Code
77427 and IMRT services under CPT Codes 77301, G6015, and G6016. (Id., ¶
200–204). Count 3 asserts that Sengar knowingly submitted or caused to be
submitted false claims for radiation treatment management services under
CPT Code 77427 and IMRT services under CPT Codes 77301, 77338, G6015,
and G6016. (Id., ¶¶ 205–209). But Scarbrough’s response to Defendants’
motion to dismiss clarifies that “the Amended Complaint does not seek to
prosecute FCA IMRT claims against Dr. Sengar.” (Doc. 46, p. 29). Finally,
Count 4 alleges that ACC, Sanford, and Sengar made or used false statements
or records material to their false claims in violation of 31 U.S.C.
§ 3729(a)(1)(B). (Doc. 41, ¶¶ 210–14).
STANDARDS OF REVIEW
Rule 12(b)(6) allows the court to dismiss a complaint if it fails to state a
claim upon which relief can be granted. “To survive a motion to dismiss, a
complaint must contain sufficient factual matter, accepted as true, to state a
claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678
(2009). In a False Claims Act action, the court must judge the sufficiency of the
complaint under the pleading requirements of both Rule 8 and Rule 9(b). See
Urquilla-Diaz v. Kaplan Univ., 780 F.3d 1039, 1051 (11th Cir. 2015).
1. Rule 8(a): Rule 8’s general pleading requirement is that the complaint
must contain a “short and plain statement of the claim showing that the
pleader is entitled to relief.” See Fed. R. Civ. P. 8(a). Rule 8 does not require
“detailed factual allegations,” but does demand more than “an unadorned, the-
defendant-unlawfully-harmed me accusation.” Iqbal, 556 U.S. at 678
(quotations omitted). Mere “labels and conclusions” or “a formulaic recitation
of the elements of a cause of action” are insufficient. Id.
2. Rule 9(b): Under Rule 9(b)’s heightened requirements for pleading
fraud, a plaintiff “must state with particularity the circumstances constituting
fraud or mistake.” Fed. R. Civ. P. 9(b). “To satisfy this heightened-pleading
standard in a False Claims Act action, the relator has to allege facts as to time,
place, and substance of the defendant’s alleged fraud, particularly the details
of the defendants’ allegedly fraudulent acts, when they occurred, and who
engaged in them.” Urquilla-Diaz, 780 F.3d at 1051 (quotations omitted).
DISCUSSION
In ruling on Defendants’ motion to dismiss, the court will address each
of the three alleged schemes in turn.
I. Claims for Radiation Treatment Management (Code 77427)
In Part I, the court denied Defendants’ motions to dismiss the claims
against Sanford and ACC related to the submission of false claims for radiation
treatment management services that Sanford allegedly provided. The court
granted Sengar and ACC’s motion to dismiss the radiation treatment
management allegations related to Sengar. Scarbrough’s amended complaint
repleads the radiation treatment management allegations included in his
original complaint. Scarbrough adds that any claims for radiation treatment
management submitted by Sengar are false because Sengar is not a radiation
oncologist.
Defendants argue that none of Scarbrough’s radiation treatment
management allegations satisfy Rule 9(b)’s heightened pleading requirements.
They also say that Scarbrough’s new allegations related to Sengar fail because
they (a) are precluded by the public disclosure bar, and (b) do not establish
materiality.
A. Dr. Sanford
“[S]ome indicia of reliability must be given in the complaint to support
the allegation of an actual false claim for payment being made by the
Government.” United States ex rel. Clausen v. Lab. Corp. of Am., 290 F.3d 1301,
1311 (11th Cir. 2002). This court evaluates “whether the allegations of a
complaint contain sufficient indicia of reliability to satisfy Rule 9(b) on a case-
by-case basis.” Atkins v. McInteer, 470 F.3d 1350, 1358 (11th Cir. 2006).
The court stands by its determination in Part I that Scarbrough’s
allegations provide a sufficient indicia of reliability that Dr. Sanford submitted
false claims to Medicare for radiation treatment management services.
Scarbrough has alleged with particularity the bases for his belief that (a) to
bill under Code 77427, a radiation oncologist must personally visit with the
patient every five fractions, and (b) Sanford doesn’t see his patients every five
fractions. Plus, Scarbrough has shown that Medicare billing data establishes
that Sanford billed Medicare for hundreds of claims under Code 77427 from
2016 to 2020.
The court rejects Sanford’s argument that Scarbrough cannot connect
this Medicare billing data to Sanford’s allegedly fraudulent conduct because
Sanford practices at both ACC’s Tuscaloosa and Winfield locations. True, the
court found in Part I that Scarbrough hadn’t adequately alleged that Sengar
submitted a false claim to Medicare for radiation treatment management
because Scarbrough’s knowledge of Sengar’s allegedly fraudulent conduct was
limited to ACC’s Anniston office. And most of Scarbrough’s allegations about
Sanford relate to Sanford’s practice at ACC’s Tuscaloosa office. But Scarbrough
also alleged that he learned from ACC Director Kevin Baker that Sanford
“never sees his patients” and this “has always been his practice.” (Doc. 41,
¶ 56). While Baker’s knowledge of Sanford’s failure to see patients was based
on discussions with Tuscaloosa radiation therapists, Baker did not qualify his
statement by saying that it applied only to Sanford’s conduct at the Tuscaloosa
office. (See id.). “At the motion-to-dismiss stage,” this court takes “the
plaintiff’s well-pleaded allegations as true. That does not change in FCA cases.”
Vargas v. Lincare, Inc., 134 F.4th 1150, 1159 (11th Cir. 2025) (citations
omitted). Accepting as true Scarbrough’s well-pleaded factual allegations,
Sanford never saw his patients at either ACC’s Tuscaloosa or Winfield offices
yet told the Government that he met his patients face-to-face by submitting
hundreds of claims under Code 77427. Because these facts could prove a viable
claim, the court DENIES Sanford’s motion to dismiss the radiation treatment
management claims brought against him.
B. Dr. Sengar
Scarbrough says that Dr. Sengar also submitted false claims under Code
77427 because (a) Sengar also doesn’t see his patients every five fractions, and
(b) he is not a radiation oncologist.
1. Face-to-face encounter allegations: In Part I, the court dismissed
Scarbrough’s radiation treatment management claims against Sengar because
Scarbrough’s knowledge of Sengar’s failure to perform face-to-face encounters
was limited to times when Scarbrough was absent from ACC’s Anniston office.
As the court explained, Sengar practices in ACC’s Anniston, Gadsden, and Ft.
Payne offices. Thus, it was possible that each of the Code 77427 claims from
Sengar on CMS’s website weren’t for the radiation treatment management
services that Scarbrough’s complaint described. Scarbrough’s amended
complaint doesn’t fix this pleading deficiency. Instead, Scarbrough asserts that
Sengar’s submission of claims under Code 77427 at any of ACC’s offices was
fraudulent because Sengar is not a radiation oncologist. Thus, to the extent
that Scarbrough is still bringing a radiation treatment management claim
against Sengar based on Sengar’s failure to have face-to-face encounters with
his patients every five fractions, the court GRANTS Sengar’s motion to
dismiss those claims for failure to satisfy Rule 9(b)’s requirements.
2. Radiation oncologist allegations: As for Scarbrough’s allegations that
Sengar’s claims under Code 77427 were false because Sengar is not a radiation
oncologist, the court agrees with Sengar that these allegations are subject to
dismissal under the False Claims Act’s public disclosure bar. So the court
needn’t address Sengar’s alternative argument that Scarbrough has failed to
plausibly allege materiality.
The False Claims Act’s public disclosure bar states:
(A) The court shall dismiss an action or claim . . . if substantially
the same allegations or transactions as alleged in the action
or claim were publicly disclosed—
(i) in a Federal criminal, civil, or administrative hearing in
which the Government or its agent is a party;
(ii) in a congressional, Government Accountability Office, or
other Federal report, hearing, audit, or investigation; or
(iii) from the news media,
unless the action is brought by the Attorney General or the
person bringing the action is an original source of the
information.
31 U.S.C. § 3730(e)(4).
The Eleventh Circuit uses a three-part to determine whether public
disclosures require dismissal of a qui tam lawsuit: (1) whether the “allegations
made by the plaintiff [have] been publicly disclosed”; (2) if so, whether the
disclosed information is substantially the same as the allegations in the
plaintiff’s lawsuit; and (3) if so, whether the plaintiff is “an ‘original source’ of
that information.” See United States ex rel. Osheroff v. Humana Inc., 776 F.3d
805, 812 (11th Cir. 2015).
A. Public disclosure: The first prong of this three-part test asks, “whether
the sources on which the defendants rely fall into the statute’s enumerated
categories of sources that are considered public.” See id. Relevant here is
whether Scarbrough’s allegation that Sengar was not a radiation oncologist
was publicly disclosed in the news media or a federal report.
Sengar relies on four sources to say that it was publicly disclosed that he
was a medical oncologist, and not a radiation oncologist, billing for services
under Code 77427. First, Sengar points out that ACC’s website identifies him
as a medical oncologist while it identifies other physicians, such as Sanford, as
radiation oncologists. See https://www.alcancercare.com/our-providers (last
visited Jan. 27, 2026). Second, the Alabama Board of Medical Examiners’
website lists Sengar’s specialty as oncology. https://dashboard.albme.gov/Veri
fication/search.aspx (last visited Jan. 27, 2026). Third, an article from the
Selma-Times Journal describes Sengar as the medical oncologist on staff at the
Cancer Care Center of Selma while noting that the cancer care center’s staff
would also include a radiation oncologist and urologist. https://www.selmatim
esjournal.com/news/cancer-care-center-of-selma-set-to-open-in-may-306993/
(last visited Jan. 27, 2026). Lastly, Sengar notes that the information
Scarbrough alleges about Sengar’s submission of claims under Code 77427,
such as how many claims Sengar submitted in any given year and Medicare’s
average payment for each claim, is publicly available on CMS’s website.
Sengar also explains that the CMS website identifies his provider type
as “Hematology-Oncology”:
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See https://data.cms.gov/tools/medicare-physician-other-practitioner-look-up-
tool/provider/1376520254?size=10&offset=0 &lastName=Sengar&firstName=
Ashvini (last visited Jan. 27, 2026) (circle added).
But CMS describes Scarbrough and Sanford’s specialties as “Radiation
Oncology”:
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□□□□□□□□□□□□□□□□□□□□□ (olen B]-) 0] adele (ele Mmm □□□□□□□□□□□□□□□□□□□□□□□□ a.
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See https://data.cms.gov/tools/medicare-physician-other-practitioner-look-up-
tool/provider/1194700625?size=10&offset=O0&lastName=Scarbrough&firstNa
me=Todd (last visited Jan. 27, 2026); https:// data.cms.gov/tools/medicare-
physician-other-practitioner-look-up-tool/provider/1689681967? size=10&
offset=O&lastName=Sanford&firstName=Shelby (last visited Jan. 27, 2026)
(circle added).
The Selma-Times Journal article “clearly qualif[ies] as news media.”
Osheroff, 776 F.3d at 813. So does ACC’s website about its physicians, clinics,
and programs. See id. And the term “news media” has “a broad sweep,” which
includes “publicly available websites intended to disseminate information.” See
United States ex rel. Jacobs v. JP Morgan Chase Bank, N.A., 113 F.4th 1294,
1301 (11th Cir. 2024) (cleaned up). Thus, the court finds that the Alabama
13

Board of Medical Examiners website also counts as news media under the
False Claims Act. Finally, “data from the CMS database is a federal report.”
See United States ex rel. Edler v. Escambia Cnty., 2023 WL 12195450, at *4
(N.D. Fla. Sept. 7, 2023). So the first requirement for public disclosure is met.
B. “Substantially the same”: Because the court concludes that the
information Sengar relies on was publicly disclosed, the court must next decide
whether the allegations in Scarbrough’s amended complaint are “substantially
the same allegations or transactions” included in the public disclosures. See 31
U.S.C. § 3730(e)(4). “This part of the test is a quick trigger to get to the more
exacting original source inquiry.” Jacobs, 113 F.4th at 1302 (quotations
omitted). As a result, “[s]ignificant overlap between [the plaintiff’s] allegations
and the public disclosure is sufficient to show that the disclosed information
forms the basis of th[e] lawsuit and is substantially similar to the allegations
in the complaint.” Id.
Scarbrough’s essential allegations related to Sengar’s submission of
claims under Code 77427 are that these claims were false because Sengar is a
medical oncologist and not a radiation oncologist. These allegations are
substantially the same as the transactions described in the public disclosures.
By itself, CMS’s website discloses that (a) Sengar submitted several claims to
Medicare under Code 77427, and (b) Sengar’s specialty is Hematology-
Oncology. And while CMS, ACC’s website, and the Selma-Times Journal all
call Sengar a medical oncologist, they identify the specialty of physicians who
are radiation oncologists as radiation oncology. Thus, you can infer from these
publicly available sources that Sengar is not a radiation oncologist.
For two reasons, Scarbrough says these transactions aren’t substantially
similar to the allegations in his amended complaint. First, while the public
disclosures consider Sengar a medical oncologist, they do not explicitly state
that Sengar does not also have the training, expertise, and education to hold
himself out as a radiation oncologist. Second, the public disclosures do not
allege that Sengar engaged in fraud or wrongful conduct.
The public disclosure bar requires only “significant overlap” between the
public disclosure and allegations in a relator’s complaint. See Jacobs, 113 F.4th
at 1302–03. It does not require “that a mirror image of the complaint’s
allegations ha[ve] been publicly disclosed.” Id. at 1303. And on their face, the
transactions described in the CMS database publicly disclose that Sengar is a
medical oncologist who has billed Medicare for claims under Code 77427. Thus,
they needn’t also explicitly state that Sengar didn’t cross train as a radiologist
to be substantially similar to the allegations in Scarbrough’s complaint.
Plus, a public disclosure needn’t “specifically allege False Claims Act
fraud” to satisfy the public disclosure bar’s “substantially the same” standard.
See id. at 1302–03. All that’s required is that the relator’s “key allegations of
fraudulent activity have significant overlap” with the public disclosures. See
id. at 1302. And here, the public disclosures fully disclose that Sengar (a) billed
Medicare for claims under Code 77427, and (b) unlike Sanford and Scarbrough,
isn’t considered a radiation oncologist. Thus, both Sengar’s alleged
misrepresentation (that he could bill Medicare for services under Code 77427)
and the true set of facts that Scarbrough says shows that misrepresentation
(that Sengar is a medical oncologist and not a radiation oncologist) were
revealed in the public disclosures. That’s enough to satisfy the second prong of
the public disclosure inquiry. See United States ex rel. Ondis v. City of
Woodstock, 587 F.3d 49, 54 (1st Cir. 2009).
C. Original source: Finally, the court decides whether Scarbrough is an
“original source;” that is, a person who has “knowledge that is independent of
and materially adds to the publicly disclosed allegations or transactions.” 31
U.S.C. § 3730(e)(4)(B). Scarbrough says that he is an original source because
he gained this knowledge while working with Sengar at ACC:
75. . . . Dr. Sengar is not trained in radiation oncology, Dr.
Sengar is not board certified in radiation oncology, he does
not practice radiation oncology, and administering radiation
has been and is outside the scope of his medical practice[.]

84. . . . [A]t no time during 2018, 2019, or 2020 was Dr.
Sengar a Radiation Oncologist.

85. During 2018, 2019, and 2020, Dr. Sengar did not
administer radiation.
(See Doc. 41, ¶¶ 75, 84, 85). These facts aren’t enough. For example,
Scarbrough hasn’t explained how he learned that administering radiation was
outside the scope of Sengar’s practice. Plus, these are the facts Scarbrough
pleads to support his conclusion that Sengar isn’t a radiation oncologist:
70. Dr. Sengar graduated medical school from the King
Georges Medical School in 1993.

71. After graduation, Dr. Sengar did an internal medicine
residency for three years and, thereafter, Dr. Sengar did a
three-year medical oncology fellowship.

72. Dr. Sengar is board certified by the American Board of
Internal Medicine. He is not board certified . . . by the
American Board of radiology in radiation oncology.

73. Since 1993, Dr. Sengar has been and is a Medical
Oncologist.

74. Medical oncologists such as Dr. Sengar treat cancers
with chemotherapy. In contrast, Radiation oncologists (such
as Relator Dr. Scarbrough) use various forms of radiation to
treat tumors.

75. Consequently, Dr. Sengar is not trained in radiation
oncology, Dr. Sengar is not board certified in radiation
oncology, he does not practice radiation oncology, and
administering radiation has been and is outside the scope of
his medical practice[.]
(Id., ¶¶ 70–75 (emphasis added)). As the court has confirmed, a quick Google
search would give any member of the public the same information about
Sengar’s status as a medical oncologist. And Scarbrough doesn’t dispute that
his knowledge of Sengar’s submission of claims under Code 77427 is based on
the data from CMS’s website. Thus, the court finds that Scarbrough’s
knowledge isn’t independent of what’s been publicly disclosed.
Nor does Scarbrough’s knowledge materially add to the publicly
disclosed allegations or transactions. The public disclosures about Sengar’s
status as a medical oncologist and his submission of claims under Code 77427
are “sufficient to give rise to an inference of fraud,” so Scarbrough’s
“cumulative allegations do not materially add to the public disclosures.” See
Jacobs, 113 F.4th at 1303 (quotations omitted). And while Scarbrough’s
knowledge about the field of oncology provides background information, which
lets him understand that the public disclosures reveal fraud, that’s not enough
to be an original source under the statute. See id. As a result, the court
GRANTS Sengar’s motion to dismiss the allegations that he submitted false
claims to Medicare under Code 77427 because he is not a radiation oncologist.
C. ACC
In his amended complaint, Scarbrough alleges that ACC is liable for the
submission of false claims under Code 77427 on behalf of Sanford, Sengar, and
Sehbai. For the reasons discussed in Part I, the court finds that Scarbrough
has adequately alleged that ACC submitted false claims for Sanford under
Code 77427. So the court DENIES ACC’s motion to dismiss the Sanford-
related Code 77427 allegations brought against it. But the court GRANTS
ACC’s motion to dismiss the Sengar-related Code 77427 allegations.
Scarbrough’s allegations about Sengar’s alleged lack of face-to-face patient
encounters do not adequately allege the submission of a false claim under Rule
9(b)’s particularity requirements. And the public disclosure bar precludes
Scarbrough’s allegations that Sengar’s status as a medical oncologist means he
cannot bill under Code 77427.
As for Sehbai, Scarbrough’s complaint establishes that Scarbrough’s
knowledge of Sehbai’s failure to satisfy the face-to-face encounter requirement
is limited to times when Scarbrough was absent from ACC’s Anniston office.
(See Doc. 41, ¶ 67). And it’s possible that each of the Code 77427 claims for
Sehbai on CMS’s website are for services rendered by Sehbai at other times.
Because submission of a false claim cannot “be inferred from the
circumstances,” Corsello v. Lincare, Inc., 428 F.3d 1008, 1013 (11th Cir. 2005),
Scarbrough hasn’t adequately alleged that the CMS data includes false claims
from Sehbai under Code 77427. The court thus GRANTS ACC’s motion to
dismiss the Sehbai-related Code 77427 allegations.
—
To sum up, the court DENIES Sanford and ACC’s motion to dismiss the
Sanford-related Code 77427 allegations. The court GRANTS Sengar and
ACC’s motion to dismiss the Sengar and Sehbai-related Code 77427
allegations. Because Scarbrough has had two chances to adequately plead his
radiation treatment management allegations, the court’s dismissal of the
Sengar and Sehbai-related allegations will be WITH PREJUDICE.
II. Claims for Image Guided Radiation Therapy (Code 77014)
Scarbrough next says that ACC is responsible for the submission of false
claims for image guided radiation therapy under Scarbrough and Harris’s NPI
numbers. ACC asks the court to dismiss the allegations related to both
Scarbrough and Harris.
A. CT Images Under Scarbrough’s NPI Number
Scarbrough asserts that to bill for CT imaging services under Code 77014
a physician must personally review, interpret, and consider the results of the
CT scan before the patient’s next fraction. (Doc. 41, ¶ 107). And while working
at ACC Scarbrough did not review CT images like Code 77014 requires. (Id., ¶
110). Yet ACC radiation technicians used Scarbrough’s NPI number to sign his
patients’ treatment records under Code 77014 and never signed these records
before the patients’ next fraction. (Id., ¶¶ 112–13). Plus, Medicare billing data
confirms that from 2018 to 2020 hundreds of claims under Code 77014 were
submitted under Scarbrough’s NPI number. (Id., ¶¶ 118–20).
In Part I, the court explained that these allegations adequately alleged
that ACC was responsible for the submission of false claims to Medicare. But
ACC asserts that Scarbrough hasn’t adequately alleged knowledge because he
hasn’t alleged that any other ACC employees knew that Scarbrough wasn’t
reviewing the CT images. The court disagrees. Under Rule 9(b) knowledge
“may be alleged generally.” Fed. R. Civ. P. 9(b). And Scarbrough has alleged
that ACC submitted false claims under Code 77014 “with knowledge that the
billing physician, including Relator Scarbrough, for whom it billed this service
did not review and sign the CT images and therefore never actually provided
the services required to bill CPT Code 77014.” (Doc. 41, ¶ 196).
Plus, the False Claims Act’s scienter requirement is satisfied when
someone acts with either actual knowledge, deliberate ignorance, or reckless
disregard. See 31 U.S.C. § 3729(b)(1). “[T]he term ‘deliberate ignorance’
encompasses defendants who are aware of a substantial risk that their
statements are false, but intentionally avoid taking steps to confirm the
statements truth or falsity.” United States ex rel. Schutte v. Supervalu Inc., 598
U.S. 739, 751 (2023). And “the term ‘reckless disregard’ similarly captures
defendants who are conscious of a substantial and justifiable risk that their
claims are false, but submit the claims anyway.” Id. After reviewing
Scarbrough’s allegations, the court finds it plausible that ACC’s employees
were at least conscious of a substantial and justifiable risk that (a) Dr.
Scarbrough hadn’t reviewed the CT images being billed under Code 77014, and
(b) no one had considered the images before the patients’ next fraction. So the
court will DENY ACC’s motion to dismiss the Code 77014 allegations related
to the billing for services under Dr. Scarbrough’s NPI number.
B. CT Images Under Harris’s NPI Number
The court reaches the opposite result for the CT images billed under
Harris’s NPI number. To support his assertion that ACC improperly used
Harris’s NPI number to bill Medicare under Code 77014, Scarbrough points to
image guided radiation therapy provided to Harris’s patient J.W. (Doc. 41, ¶
123). Scarbrough says that J.W., a Medicare patient, received two image
guided radiation therapy treatments per day, five days a week. (Id.). He then
says that before each of these treatments, J.W. received a CBCT image that
was billed to Medicare under Harris’s NPI number. (Id.). But Harris did not
know that ACC was billing Medicare for these services and did not sign the
images as required to bill for the service. (Id.). Instead, a radiation technician
at the ACC Anniston office signed these images under Harris’s NPI number.
(Id.). And these forged signatures weren’t executed until weeks after the
service was performed. (Id.). For example, the CBCT image performed on May
17, wasn’t signed until May 31. (Id.).
Under Rule 9(b), it isn’t enough to generally allege that a patient was a
Medicare beneficiary and his insurance was billed under a fraudulent scheme.
See United States ex rel. McKoy v. Atlanta Primary Care Peachtree, P.C., 2025
WL 1823269, at *7 (11th Cir. July 2, 2025). Instead, a relator must provide
“specific information about the submission of claims to the Government.” See
Clausen, 290 F.3d at 1311. Because Scarbrough doesn’t plead any facts to
support his conclusory assertion that ACC billed Medicare for J.W.’s CBCT
images, the court GRANTS ACC’s motion to dismiss the Code 77014
allegations related to the billing for services under Dr. Harris’s NPI number.
See id. at 1312 (affirming dismissal of complaint that discussed in detail a
handful of patients’ lab results but that offered no factual basis for conclusory
allegation that the defendant billed claims related to those lab results to the
Government). As with Scarbrough’s Sengar and Sehbai-related Code 77427
allegations, the court’s dismissal of the Harris-related Code 77014 allegations
will be WITH PREJUDICE.
III. Claims for IMRT Services (Code 77301, 77338, G6015, G6016)
The final alleged fraudulent scheme relates to ACC’s submission of
claims for IMRT services from 2016 to 2020. According to Scarbrough, these
claims were false because ACC stopped performing required patient specific
QA in 2016 and thus the IMRT services provided weren’t reasonable or
medically necessary. In Part I, the court found that Scarbrough adequately
alleged under Rule 9(b) that ACC and Sanford submitted claims for services
using ACC’s new software only verification process. But the court found that
Scarbrough hadn’t adequately alleged that (a) Sengar submitted or caused to
be submitted claims for reimbursement for IMRT services, or (b) the claims
ACC and Sanford submitted were objectively false. Thus, the court dismissed
without prejudice Scarbrough’s IMRT services’ allegations.
In his amended complaint, Scarbrough repleads his IMRT services
claims against ACC and Sanford.1 ACC and Sanford say that the court should
dismiss these claims for failing to establish presentment, falsity, or scienter.

1 Scarbrough’s response brief clarifies that he “does not seek to prosecute FCA IMRT claims
against Dr. Sengar.” (Doc. 46, p. 29). So the court DISMISSES WITH PREJUDICE the
amended complaint’s IMRT allegations against Sengar.
The court stands by its ruling in Part I that Scarbrough adequately
alleges that ACC and Sanford submitted claims for services using ACC’s new
software-only verification process. Again, Scarbrough alleges with
particularity that ACC removed patient specific QA at all ACC facilities in
January 2016. And Scarbrough has shown that Medicare billing data
establishes that Sanford and other ACC physicians billed Medicare for IMRT
services from 2016 to 2020. Thus, the court rejects ACC and Sanford’s
argument that Scarbrough has failed to plead with particularity that ACC and
Sanford submitted claims for IMRT services using the software-only
verification process. The court addresses ACC and Sanford’s falsity and
scienter arguments below.
A. Falsity
Scarbrough says each of ACC’s claims for IMRT services from January
2016 onward were false because Medicare doesn’t reimburse providers for
services that aren’t “reasonable and necessary for the diagnosis or treatment
of illness or injury.” See 42 U.S.C. § 1395y(a)(1)(A). A service is “reasonable
and necessary” if “the service has been proven safe based on authoritative
evidence . . . or . . . is generally accepted in the medical community as safe and
effective for the condition for which it is used.” 54 Fed. Reg. 4302, 4304 (Jan.
30, 1989). Thus, to show that ACC and Sanford submitted false claims for
IMRT services, Scarbrough must plausibly allege that it was false to certify
that ACC’s QA testing procedures were generally accepted in the medical
community as safe and effective. See 31 U.S.C. §§ 3729(a)(1)(A), (a)(1)(B).
In Part I, the court dismissed Scarbrough’s IMRT services claims on
falsity grounds because Scarbrough alleged that the QA process for IMRT
services requires patient specific end-to-end testing using a phantom or
equivalent testing procedure but failed to adequately explain why the medical
community wouldn’t accept ACC’s software verification system as an
equivalent testing procedure. The amended complaint clarifies that the
medical community considers IMRT services safe and effective only if a medical
provider (1) verifies “that the calculated beams or arcs are delivered to a
phantom or a dosimetry measuring device; and” (2) confirms “that the intended
dose will be accurate and feasible in accordance with the patient’s specific
treatment plan.” (Doc. 41, ¶ 158 (emphasis in original)).
According to Scarbrough, ACC’s software verification system does not
follow these procedures because it does not verify the radiation delivery
machines via physical phantoms or a calibrated dosimetry measuring device.
(Id., ¶¶ 155–58). Nor is ACC’s use of a virtual phantom, which does not include
the patient’s custom designed treatment plan, equivalent to irradiating the
physical phantoms that the medical community deems safe and effective. (See
id., ¶¶ 159–60, 168–70). To support these allegations, Scarbrough cites a
practice guideline from the American College of Radiology and American
Society for Radiation Oncology plus LCD L39553. (Id., ¶¶ 145–48). The
practice guideline says that “[b]efore the start of treatment and using all of the
parameters of the patients’ treatment plan, the accuracy of dose delivery
should be documented by irradiating a phantom containing a calibrated
dosimetry system to verify that the dose delivered is the dose planned.” (Id., ¶
145 (emphasis added)). LCD L39553 explains that “[t]he distinguishing feature
of an IMRT plan is that it demonstrates how treatment with non-uniform beam
intensities will be delivered.” (Id., ¶ 147 (emphasis omitted)). It then adds that
“calculated beams or arcs” should be “delivered to a phantom or a dosimetry
measuring device to confirm the intended dose will be accurate and that
delivery will be technically feasible.” (See id. (emphasis omitted)).
On their face, Scarbrough’s allegations plausibly allege that the medical
community wouldn’t generally accept ACC’s software only verification system,
which fails to consider the patient’s specific treatment plan, as a safe and
effective IMRT QA process. But for three reasons Defendants say Scarbrough
has not “plausibly allege[d] that the specific form of patient-specific end-to-end
testing that he insists was ‘required’ by Medicare in order to properly submit
a claim for reimbursement for IMRT treatment was in fact required.” (Doc. 44,
p. 32). First, Defendants point out that LCD L39553 wasn’t established until
December 2023 and that LCDs are non-binding guidelines that do not carry
the force of law. Second, Defendants say that Scarbrough hasn’t alleged that
Medicare adopted the practice guideline before issuing the LCD or provided an
alternative reason for why following the guideline was required to receive
Medicare reimbursement. Finally, Defendants say that Scarbrough cannot rely
on this practice guideline because the guidelines themselves recognize that “an
approach that differs from the guidelines, standing alone, does not necessarily
imply that the approach was below the standard of care.” (Id., p. 34).
But ACC and Sanford’s challenges to the LCD and practice guidelines
merely highlight a fact dispute over whether the medical community would
consider ACC’s IMRT QA process safe and effective. True, the LCD is non-
binding and wasn’t in effect during the time relevant to ACC and Sanford’s
alleged submission of false claims. But Scarbrough alleges that the LCD
“essentially adopts the decades old industry standards” for IMRT services.
(Doc. 41, ¶ 146). And Medicare needn’t have adopted the practice guideline for
it to support Scarbrough’s contention that ACC’s procedures for IMRT services
aren’t generally accepted. Plus, while the practice guidelines say that a
different approach doesn’t necessarily fall below the standard of care, this
statement doesn’t definitively establish that the medical community would
accept ACC’s IMRT procedures as safe and effective.
“[F]actual disputes are not grounds for dismissal at” the motion-to-
dismiss stage. See Vargas, 134 F.4th at 1160. And this court must “accept the
complaint’s well-pleaded allegations as true and draw all reasonable inferences
in the relators’ favor.” See id. at 1159. Viewing the amended complaint in the
light most favorable to Scarbrough, he has adequately alleged that it was false
to claim that ACC’s QA testing procedures were generally accepted in the
medical community as safe and effective. So the court rejects the argument
that it should dismiss the IMRT services claims on falsity grounds.
B. Scienter
ACC and Sanford finally assert that Scarbrough has failed to adequately
allege that they knew their claims for reimbursement for IMRT services were
false because ACC’s QA testing procedures are not generally accepted as safe
and effective. The court disagrees. Again, the False Claims Act’s scienter
requirement is satisfied when someone acts with either actual knowledge,
deliberate ignorance, or reckless disregard. See 31 U.S.C. § 3729(b)(1). A
defendant is deliberately ignorant if he is “aware of a substantial risk that” his
“statements are false, but intentionally avoid[s] taking steps to confirm the
statements truth or falsity.” Supervalu Inc., 598 U.S. at 751. And a defendant
acts with reckless disregard when he is “conscious of a substantial and
justifiable risk that” his “claims are false, but submit[s] the claims anyway.”
Id. Plus, under Rule 9(b), a defendant’s knowledge can be alleged generally.
See Fed. R. Civ. P. 9(b).
The amended complaint adequately alleges that ACC and Sanford were
aware of a substantial and justifiable risk that their QA process for IMRT
services was deficient and in violation of Medicare Conditions of Payment. To
be certain, in April 2017, Scarbrough says he emailed Mills and Sanford to tell
them that he believed ACC’s procedures violated Medicare’s requirements.
(Doc. 41, ¶ 165). And in this email, Scarbrough highlighted why he believed
ACC failed to meet the medical community’s requirements for IMRT QA. (Id.,
¶ 166). According to Scarbrough, Mills responded to Scarbrough’s email by
paying “mere lip service to the idea of patient specific QA procedures.” (Id., ¶
173). And nothing in the amended complaint suggests that Sanford ever took
any steps to confirm that the IMRT services he was billing for included a safe
and effective QA process. Accepting these allegations as true, they plausibly
suggest that ACC and Sanford acted with either deliberate ignorance or
reckless disregard of whether their claims that the IMRT QA process was
generally accepted by the medical community as safe and effective were false.
So the court will DENY ACC and Sanford’s motion to dismiss the IMRT
services-related allegations.
CONCLUSION
For these reasons, the court GRANTS IN PART and DENIES IN
PART Defendants’ motion to dismiss (doc. 44). These claims will proceed
through discovery:
1. The Sanford-related radiation treatment management claims
against ACC and Sanford;
2. The Scarbrough-related Image Guided Radiation Therapy
claims against ACC; and
3. The IMRT services claims against ACC and Sanford.
All other claims are DISMISSED WITH PREJUDICE. ACC and
Sanford will have until on or before February 10, 2026, to answer the
amended complaint.
The court will enter a separate order that carries out this ruling and
directs the Clerk of Court to terminate Sengar as a defendant listed on the
docket sheet.
Done on January 27, 2026.

Aonnye’ MAZE 2
UNITED STATES DISTRICT JUDGE

25

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/11246836. Public record. Not legal advice.