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Oncology Clinic Settles FCA Suit for $26M

Posted  December 13, 2017

By the C|C Whistleblower Lawyer Team

Florida-based 21st Century Oncology Inc. and several of its subsidiaries have settled allegations regarding the practice’s use of Electronic Health Records (EHR) software. The settlement is a result of a self-disclosure of violations made under Medicare’s EHR incentive program. The incentive program allows healthcare providers that attest to meaningful use of their EHR programs to receive bonus payments as compared to providers who keep paper records or use poorly run EHR programs. In its self-disclosure, the company admitted that they submitted false attestations certifying the meaningful use of their program. Those submissions involved employees falsifying data, fabricating software utilization reports, and superimposing well-known EHR vendor logos onto the reports to make them look more legitimate. Read more here.

The settlement also includes payments over alleged violations of the Stark Law. According to the government, the practice group was paying physicians salaries well above market rate to capture their referrals for tests and other medical procedures. Unlike the self-disclosed violations involving the EHR software, the Stark Law violations were brought to light by a whistleblower. Matt Moore, a former Interim VP of Financial planning, will receive a $2M award for his tip.

In addition to the monetary settle, 21st century oncology has entered into a five-year corporate integrity agreement. The CIA obligates 21st Century to undertake substantial compliance reforms, including hiring independent review organizations to conduct audits.

This is the fourth, recent whistleblower case involving EHR software. In May, eClinicalWorks(ECW) settled a False Claims Act case for $155M. In that case, the company allegedly misrepresented the capabilities of its software when the EHR has being tested for CMS certification, which comes with its own incentive payments. Instead of developing software that met the relevant requirements, ECW allegedly designed software to pass the certification requirements without actually meeting the certification criteria. In early November, an unsealed suit against EPIC, another EHR provider, alleged that the company designed software that double-billed Medicare for anesthesia services. And in late November, an unsealed suit against 62 hospitals and CIOX Health (another EHR provider) alleged that the hospitals represented the speed at which their software operated, in violation of standards that led to incentive payments.

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,