Court Orders Florida Oncologist to Pay $89.6 Million After False Claims Act Judgment

Thursday, May 29, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Talk about cracking down on Medicare fraud. On May 14, 2014, a Brevard County radiation oncologist received his final judgment in a whistleblower Medicare fraud case. The doctor, who owned the American Cancer Treatment Centers with offices in Titusville and Rockledge for nearly 20 years, was ordered to pay the United States $89.6 million. The doctor was charged with defrauding Medicare under the False Claims Act. Both of his offices have been closed and sold.

According to Florida Today, the final judgment was ordered by the U.S. District Court for the Middle District of Florida in Tampa. The doctor will have 30 days to appeal the ruling.

To read more from the Florida Today article, click here.


Details of the Sneaky Scheme.

In 2012 a former employee filed a lawsuit against the oncologist claiming the cancer treatment facility owner had been falsely billing Medicare for services it wasn't capable of performing. The whistleblower who brought the falsified actions to light had been a radiation therapy technologist in the office for more than two years. The former employee testified that the doctor had allegedly instructed the staff to bill Medicare on a daily basis for procedures performed incorrectly or not performed at all. According to the Florida Today article, court records showed that the oncologist ordered staff to bill for procedures performed with a certain type of imaging machine, a machine the centers didn't even have in their possession.

The oncologist denied all the allegations claiming they were falsified by a disgruntled former employee, according to the Orlando Sentinel. The doctor never formally presented a defense against the accusations. His inaction was due to his incorrect belief that an ongoing 2012 bankruptcy filing for his medical practice had halted action in the whistleblower case. The lesson learned here: don't ever make such bold assumptions.

Click here to read more from the Orlando Sentinel.


The Legalities of Such Cases.

This case was brought under the federal False Claims Act which mandate's standards and regulations for both civil and criminal penalties against those falsely billing the government. Most states have enacted their own specific version of whistleblower laws. False claims cases, such as this recent one, are typically carried out in a qui tam (or whistleblower) proceeding. This type of action involves a private party filing a lawsuit against a defendant who allegedly is defrauding the government. Usually these types of cases are designed to protect the whistleblowers from receiving any potential prosecution or punishment due to involvement in the fraudulent actions.

The government urges healthcare providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act serves as a system of rewards which encourages whistleblowers to bring these issues to the government's attention. Under current whistleblower laws, the former American Cancer Treatment Center employee who exposed the oncologist's fraudulent behavior could receive ten percent (10%) to thirty percent (30%) of any damages recovered from the case.

I have written a detailed two-part blog series discussing the ins and outs of false claims lawsuits involving whistleblowers in the healthcare industry. To read part of one that blog, click here. To read part two of that blog, click here.


Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent healthcare professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in healthcare accounting, healthcare financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.


Source:

Brinkmann, Paul. "Brevard Oncologist Loses $89M Medicare Fraud Judgment." Orlando Sentinel. (May 19, 2014). From: http://bit.ly/1pvFyCD

McClung, Chuck. "Brevard Doctor Ordered to Pay Medicare $90M." (May 27, 2014). From: http://on.flatoday.com/1vBJZAd


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


Tag Words: False Claims Act, FCA, qui tam lawsuit, defense attorney, litigation, whistleblower, whistleblower lawsuit, whistleblower protection, fraud defense, fraud prevention, Medicare, Medicare fraud, defense attorney, defense lawyer, legal representation, government health programs, Medicare audit, Florida Medicare, oncologist, radiation oncologist, Florida healthcare, fraud schemes, Medicare overbilling, whistleblower settlement, The Health Law Firm



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5/29/2014

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