One of US' largest cancer care providers, 21 Century Oncology Inc accused of improper Medicaid billing and inappropriate use of procedure has settled claims with the federal government for $34.7 million.
21 Century Oncology Inc with multiple locations in Jacksonville and its subsidiary South Florida Radiation Oncology LLC allegedly performed and billed procedures that were not needed. The U.S. Department of Justice said physicians and physicists who performed Gamma function procedure to patients were not knowledgeable and skilled to interpret the results, Yahoo reported. The oncology company reportedly billed Medicaid for the procedures with no final results or in case the equipment failed.
"Today's settlement demonstrates our unwavering commitment to protect the Medicare trust fund against unscrupulous providers," said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department's Civil Division, in a statement, according to Court House News. "Providers who waste taxpayer dollars by billing for unnecessary services, including services that are not used or improperly performed, will face serious consequences."
Whistleblower Joseph Ting, a previous physicist of South Florida Radiation Oncology alleged that 21 Century Oncology Inc was aware of the Medicaid and TRICARE billing procedure from the period 2009 to 2015. Ting testified that physicians who performed GAMMA procedures were not trained, WOKV claims. Ting will receive $7 million under the whistleblower provisions of the False Claims Act. He filed the lawsuit against 21 Century Oncology Inc in 2014. GAMMA function is a procedure that measures the emitted radiation after treatment.
"The United States Attorney's Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud," says U.S. Attorney A. Lee Bentley, III in a statement. "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 settlement of 21 Century Oncology Inc was one of its largest agreements made in the previous months. In December, 21 Century Oncology Inc's subsidiary, 21st Century Oncology LLC settled a $19.75 million lawsuit over its violation on the False Claims Act. The company was found illegally billing needless urine tests. They also encouraged doctors to order the test without the patients' need in exchange of bonuses.
