In The News

State-of-the-Art Cancer Treatment Provider Agrees to Pay $26 Million to Settle Alleged False Claims Act Violations

The number of many physicians who are incentivized to enter into illegal financial arrangements with health care providers is still quite alarming despite the government’s ongoing campaign against such actions. This was demonstrated earlier this month when the Department of Justice announced that 21st Century Oncology Inc – an integrated cancer care provider based in Florida – and several of its affiliates and subsidiaries have agreed to pay $26 million to settle charges that it electronically submitted false claims to Medicare in violation of the False Claims Act and that it engaged in improper financial relationships with several physicians. “The Justice Department is committed to zealously investigating improper financial relationships that have the potential to compromise physicians’ medical judgment,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “However, we will work with companies that accept responsibility for their past compliance failures and promptly take corrective action.” 21st Century Oncology, which operates several facilities throughout the United States, employs physicians in several specialty fields including radiation oncology, medical oncology and urology.

The settlement reached between the United States and 21st Century Oncology resolves behaviors that the company engaged in and eventually disclosed to the Justice Department involving the Medicare Electronic Health Records (EHR) Incentive Program. The Medicare EHR Incentive Program is designed to help physicians to receive incentive payments and avoid downward adjustments in certain Medicare claims. This is only to be the case when physicians can attest to the meaningful use of certified EHR technology. 21st Century Oncology disclosed that it knowingly submitted false attestations to CMS concerning employed physicians’ use of EHR software. The company further disclosed that it falsified data regarding the use of EHR software, made up utilization reports and that it copied EHR vendor logos onto reports in order to make them appear to be legitimate.

“This settlement represents our office’s continued commitment to ensuring compliance with important federal health care laws,” said Acting U.S. Attorney Stephen Muldrow of the Middle District of Florida. “We appreciate that 21st Century Oncology self-reported a major fraud affecting Medicare, and we are also pleased that the company has agreed to accept financial responsibility for past compliance failures.” In addition to False Claims Act violations, the settlement also resolves allegations that 21st Century Oncology violated the physician self-referral law also known as “Stark Law.” The Stark Law prohibits physicians from referring patients for certain designated health services paid for by Medicare to any entity in which they have a “financial relationship.” The government alleges that 21st Century Oncology violated this law by submitting claims for services performed pursuant to referrals from physicians whose compensation did not satisfy any exception to the Stark Law.

The Stark Law allegations were brought about as the result of a lawsuit that was filed by Matthew Moore, 21st Century Oncology’s former Interim Vice President of Financial Planning under the qui tam provisions of the False Claims Act. Under this Act, private parties are allowed to sue for false claims on behalf of the government and to share in any recovery. Mr. Moore will receive $2 million as his share of the recovery. 21st Century Oncology has also agreed to enter into a five-year Corporate Integrity Agreement (CIA) with the Office of Inspector General of the United States Department of Health and Human Services (HHS-OIG) as part of the settlement. The CIA obligates 21st Century to undertake certain compliance reforms and to hire an organization to conduct an independent review of its practices.