In The News

United States Settles False Claims Act Allegations against 21st Century Oncology for $34.7 Million

Last month the Department of Justice announced that 21st Century Oncology, Inc., had agreed to settle allegations that it performed and billed patients for unnecessary medical procedures.  The company is headquartered in Fort Myers, Florida and has offices in 16 states.  Specifically, the government alleged that 21st Century knowingly and improperly billed for a procedure called Gamma function which measures the exit dose of radiation from a patient after receiving radiation treatment.  The government alleged that (a) 21st century performed and billed for the procedure when there was no medically appropriate reason to do so and that (b) it used physicians and physicists who were not trained to interpret and utilize the results of said tests.  Moreover, the government alleged that 21st Century billed for the procedure when no physician had reviewed the results for seven or more days after the last day patients received the procedure.  Finally, the government alleged that 21st Century billed for the procedure when results from the test were not available due to technical failures in the imaging equipment.

“The U.S. Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud,” said U.S. Attorney A. Lee Bentley III for the Middle District of Florida.  “Healthcare providers may bill for new technologies only when they have been proven to be useful and when individual physicians and staff have been trained to use them properly.”  The lawsuit was filed under the qui tam provisions of the False Claims Act by Joseph Ting, a former physicist at South Florida Radiation Oncology.  Under the Act, private parties can sue on behalf of the government and receive a portion of any recovery in cases of governmental fraud.  Ting’s portion of the settlement comes to more than $7 million.  “The waste of health care program dollars will not be tolerated,” said Special Agent in Charge Shimon R. Richmond for the Health and Human Services (HHS) Office of the Inspector General.

Last December, 21st Century paid $19.75 million to settle allegations that it violated the False Claims Act by billing for medically unnecessary urine tests and for encouraging physicians to order these test by offering bonuses based on the number of patients the physicians could refer to its laboratories.  The settlement comes as part of the government’s ongoing efforts to combat health care fraud via its Health Care Fraud Prevention and Enforcement Action Team (HEAT.)  The initiative was announced back in May of 2009 by then Attorney General Eric Holder and then Secretary of Health and Human Services Kathleen Sebelius.  The initiative has resulted in the recovery of $27.4 billion through False Claims Act cases with more than $17.4 billion of that amount recovered in cases involving fraud against federal health care programs.

“This settlement highlights the commitment of the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of TRICARE, the Department of Defense health care program that serves our warfighters, their family members, and military retirees,” said Special Agent in Charge John F. Khin of DCIS Southeast Field Office.  If you know of fraud that has been committed against a government program or agency you are encouraged to report it and to contact a qui tam law firm for advice.