Radiation oncology providers in Pensacola, Fla. will pay $3.5 million to the federal government and the state of Florida to settle a whistleblower suit alleging they improperly billed government program--including Medicare, Medicaid and TRICARE--for radiation oncology services.
The providers in the case--Gulf Region Radiation Oncology Centers Inc. (GRROC), Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Gerald Lowrey and Rod Krentel--were alleged to have regularly billed for radiation oncology services between 2007 and 2011 that were not supervised by a physician.
"These services were often performed while the defendant doctors were on vacation or were working at another radiation oncology clinic," a statement released Sept. 13, by the U.S. Department of Justice said. The government also alleged the providers billed for other services, even though patient records gave no indication that services had been performed; billed twice for the same services; and misrepresented the level of service provided in order to increase the amount of reimbursement they received from the federal government.
"Submitting false claims for medical services raises the cost of healthcare for all of us as patients and taxpayers," Pamela Marsh, U.S. Attorney for the Northern District of Florida, said in a statement. "Patients, employees and others who suspect billing fraud on the part of healthcare providers should not hesitate to report such fraud to federal authorities. Healthcare providers--both corporations and individuals--must be held accountable when they submit false information."
Under the whistleblower provisions of the False Claims Act, Richard Koch--a former employee of GROCC--will receive more than $600,000 from the federal share of the settlement amount.
A statement released by GROCC said it has "disputed the lawsuit for the past 17 months and we are pleased to settle the matter and avoid further protracted litigation and substantial legal costs." It went on to say that the care provided in its facilities and by its physicians "was always safe, medically necessary and appropriate."
According to an article published in AuntMinnie.com last December, a Florida court ordered the federal government to attempt to mediate a settlement in the case because of its complexity.
To learn more:
- see the statement from the DOJ
- read the article in Auntminnie.com