Florida Radiation Oncology Providers Pay $3.5 Million for Medicare, Medicaid, and TRICARE Scheme; Whistleblower to Receive $609,796.
September 25, 2013 – On September 13, 2013, the U.S. Justice Department announced a $3.5 million settlement with several Florida-based radiation oncology providers.
The settlement was intended to resolve allegations that the radiation providers submitted false claims to the U.S. government by engaging in medical billing fraud.
The providers named in the government’s complaint are 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. The Complaint alleged that these providers engaged in a billing fraud scheme from 2007 through 2011 which included billing for radiation oncology services that were not supervised by a physician as required by Medicare, Medicaid, and TRICARE. Although physician supervision was a requirement for reimbursement, the defendant providers, nonetheless billed for services when the physicians were on vacation and otherwise not on site. In addition, the defendant providers billed for services that were never performed, an illegal practice known as “phantom billing.” They also billed the government twice for services that were only performed once, a fraudulent practice known as “double-billing.”
The allegations in the government’s complaint were initially raised in a complaint filed by a whistleblower under the qui tam provisions of the False Claims Act. The relator-whistleblower was a former administrator at GRROC. He will receive approximately $609,796 from the federal share of the settlement.
If you have information regarding healthcare fraud of any kind, including improper billing or the failure to properly supervise, contact the whistleblower attorneys at Levy Konigsberg LLP for a free, confidential consultation.