September 25, 2013 — Health care providers in Pensacola, Florida have consented to pay $3.5 million to settle a False Claims Act lawsuit alleging that the providers submitted false claims to Medicare, Medicaid and TRICARE for radiation oncology services. The whistleblower lawsuit provides just one example of the massive health care fraud problem in our country. To combat the fraud, the U.S. Justice Department relies on information from tipsters. The qui tam language in the federal False Claims Act authorizes informants to fight fraud directly by bringing a lawsuit on behalf of the government. To encourage inside employees to take the difficult step of coming forward, the Act allows whistleblowers to share a portion of any funds recouped by the government.
Radiation Oncology Providers Agree to $3.5 Million Settlement to Resolve Allegations of False Claims to Medicare, Medicaid and TRICARE
The U.S. government and the State of Florida have reached a settlement with several Florida health care providers who allegedly billed state and federal healthcare programs for radiation oncology services that were not reimbursable under program guidelines. According to the Justice Department, the defendants in the whistleblower lawsuit included:
- Gulf Region Radiation Oncology MSO LLC,
- Gulf Region Radiation Oncology Centers Inc. (GRROC),
- Sacred Heart Health System Inc.,
- Emerald Coast Radiation Oncology Center LLC (ECROC),
- West Florida Medical Center Clinic P.A.,
- Dr. Rod Krentel and
- Dr. Gerald Lowrey.
Medicare, Medicaid and TRICARE require that radiation oncology services be supervised by a doctor. But from 2007 to 2011, the defendants routinely billed for services performed when the defendant physicians were working at another facility or were on vacation. In addition, the defendants allegedly billed for other services even when they were not in fact provided, insofar as the patients’ medical records indicated. The defendants also were alleged to have double-billed for the same services and to have upcoded their billings by claiming to have provided a higher level of service than actually performed.
The allegations of health care fraud first came to light in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower, Richard Koch, is a former employee of GRROC. Koch will receive over $600,000 from the federal government’s share of the settlement.
Whistleblowers Uncover Health Care Fraud
As in this case, employee insiders often are best situated to spot Medicare and Medicaid fraud operations. Informants should learn about their own rights under the False Claims Act, however, prior to notifying authorities of health care fraud. The whistleblower lawyers with Waters & Kraus are highly skilled in working with tipsters willing to collaborate with the government. Contact us by email or call our False Claims Act attorneys at 855.784.0268 to discuss our national qui tam practice.