Thanks to a whistleblower, the Department of Justice has announced yet another Medicare fraud settlement with a group that was charging full physician rates for work that was actually being done by non-physicians. In this particular False Claims Act lawsuit, the allegations of Medicare fraud and Medicaid fraud are particularly disturbing; according to the Government's and the whistleblower's lawyers, Emerald Coast Radiation Oncology Center LLC, physicians were billing for radiation oncology services that they were supposed to be supervising - when in fact the doctors were not even present, much less supervising the work. The defendants paid the Government a combined $3.5 million.
Certainly if I had to undergo radiation I would expect a doctor to be supervising what was happening, and apparently Medicare's regulations demand nothing less. In this case, it sounds as if the doctors were not even particularly subtle about flaunting the Medicare rule; the doctors even billed for supervising procedures while they "were on vacation or were working at another radiation oncology clinic."
Now that's a trick: billing for work you are doing in Florida, when you are really miles away . . . well, I was about to say lying on a beach somewhere, but then I recalled that these doctors already live on the Gulf Coast in Florida, so I instead I will say . . . skiing on a mountain slope.
Medicare and Medicaid found out about the fraud from whistleblower Richard Koch, a former employee of Gulf Coast Radiation Oncology Centers. Koch filed a qui tam lawsuit under the False Claims Act, meaning that he brought the case on behalf of the Government. In order to encourage whistleblowers like Koch to come forward, the False Claims Act (FCA) calls for the Government to give a percentage of what it recovers to the whistleblower who stuck his neck out to let them know they were being ripped off.
In this case, the Government passed $609,796 of its recovery along to Koch. Under the FCA statute, a whistleblower is entitled to between 15% and 25% of the amount that the Government collects as a result of the lawsuit he brings (the percentage can go as high as 30% if the Government chooses not to intervene).
This is by no means the first False Claims Act lawsuit where a doctor's group has had to reimburse the Government because it fraudulently billed as if a doctor was performing services, when in reality the procedures were being done by a P.A., nurse, or even an unlicensed technician. I have written several entries about the surprising number of allegations that anesthesiology practices have billed a high rate for doctor-performed anesthesia, when the anesthesia services should have been charged at a lower rate because they in fact were performed by a nurse anesthetist.
Medicare was alerted supposed to supervise Emerald Coast billed as if physiciansfor will bills for radiation oncology services that were supposed to be supervised by physicians.
The whistleblower in this FCA lawsuit is a former employee of Emerald Coast. The settlement involved a number of other Defendants, as well: Gulf Region Radiation Oncology Centers Inc. (GRROC) and Gulf Region Radiation Oncology MSO LLC, were accused of fraud and participated in the settlement, as did Sacred Heart Health System Inc., and West Florida Medical Center Clinic P.A. Two individual doctors, Dr. Gerald Lowrey and Dr. Rod Krentel, were sued and participated in the settlement.