Florida Oncologists Pay $3.5 Million to Settle Whistleblower/Qui Tam Fraud Claims
Monday, September 23, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawA group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5 million, according to the Department of Justice (DOJ) on September 13, 2013. The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. According to the DOJ press release, the defendants include Gulf Region Radiation Oncology Centers Inc. (GRROC), Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Dr. Gerald Lowrey and Dr. Rod Krentel. Click here to read the press release from the DOJ.Defendants Accused of Improper Billing.The government alleged that the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE. In the press release, the DOJ states that these services were sometimes performed while the defendant physicians were on vacation or working at a different radiation oncology clinic. The government alleged that the defendants billed for services never rendered. The DOJ also accused the defendants of double billing for the same services and misrepresented the level of service provided to increase their reimbursements.
Settlement Includes Integrity Agreement.The defendants will pay the government back $3.5 million as a result of the alleged fraud, and a civil penalty between $5,000 and $10,000 for each of about 6,450 claims, according to Law360. On top of the $3.5 million pay out, some of the defendants entered into an Integrity Agreement with the U.S. Department of Health and Human Services’ Office of the Inspector General (HHS-OIG). The agreement is intended to deter future misconduct. It requires enhanced accountability and monitoring activities. Click here to read the Law360 article.
Most Qui Tams Filed by Employees.According to Law360, the lawsuit was first filed as a whistleblower or qui tam complaint in 2010, by a former employee of GRROC. In the complaint the ex-employee alleged that he was fired in retaliation for voicing his concerns over the oncology center’s billing practices.From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.Attorneys with The Health Law Firm also represent health care 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 health care accounting, health care 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.Sources:Department of Justice. “Florida Doctors, Hospitals and Clinics to Pay $3.5 Million to Settle Allegations of Improper Medicare, Medicaid and TRICARE Billing.” Department of Justice. (September 13, 2013). From: http://www.justice.gov/opa/pr/2013/September/13-civ-1027.htmlMcVay, Richard. “Fla. Oncologists Pay $3.5M To Settle Medicare Fraud Claims.” Law 360. (September 16, 2013). From: http://www.law360.com/articles/472981/fla-oncologists-pay-3-5m-to-settle-medicare-fraud-claimsTag Words: qui tam, qui tam lawsuits, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection, Emory University, Emory University hospital, settlement agreement, defense attorney, defense lawyer, Department of Justice (DOJ), false billing, false claims, false claims act, legal representation, medicare, medicare audit, Medicare false claims, Medicare fraud, Medicaid, Medicaid audit, Medicaid false claims Winship Cancer Institute, clinical trial research, The Health Law Firm
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