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DOJ Catch of the Week -- 21st Century Oncology

Posted  March 11, 2016

By the C|C Whistleblower Lawyer Team

This week’s Department of Justice “Catch of the Week” goes to 21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider.  On Tuesday, the Florida-based company and its wholly owned subsidiary South Florida Radiation Oncology agreed to pay $34.7 million to settle charges they violated the False Claims Act by performing and billing for cancer care procedures that were not medically necessary or properly provided.  See DOJ Press Release.

According to the government, the companies improperly billed for Gamma function procedures — which measure radiation doses — under circumstances where there was no medically appropriate purpose for the treatment.  The government pointed to three specific examples of this alleged misconduct: performing the procedure by individuals not properly trained to interpret the results; billing for the procedure when the results were not reviewed in a timely fashion (i.e., until seven days or more after the patients received radiation treatment); and billing for the procedure even when no result was available due to technical failures in the imaging equipment.

In announcing the settlement, the government stressed its commitment to going after “unscrupulous” healthcare providers.  DOJ Civil Division Chief Benjamin Mizer warned, “providers who waste taxpayer dollars by billing for unnecessary services, including services that are not used or improperly performed, will face serious consequences.”  And Health and Human Services Special Agent Shimon Richmond added that “the waste of health care program dollars will not be tolerated,” noting that 21st Century Oncology “performed tests that were not only medically unnecessary, but that no one had been trained to properly interpret, thereby allegedly causing the taxpayers to pay for useless tests.”

The allegations leading to the settlement originated in a whistleblower lawsuit filed by Joseph Ting, a former physicist at South Florida Radiation Oncology, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of more than $7 million from the proceeds of the government’s recovery.  This settlement follows on the heels of the $19.75 million settlement 21st Century Oncology Inc. subsidiary 21st Century Oncology LLC agreed to pay in December to settle charges of billing for medically unnecessary laboratory urine tests and for paying kickbacks to encourage physicians to order the tests.

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,