Radiation oncology providers in Pensacola, Fla., will pay $3.5 million to the government and the state of Florida to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment, the Justice Department announced today. The defendants include 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), Dr. Gerald Lowrey and Dr. Rod Krentel.
The government alleged that between 2007 and 2011, the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE, and that, in fact, these services were often performed while the defendant doctors were on vacation or were working at another radiation oncology clinic. The government also alleged that the defendants billed for other treatment services even when patients’ medical records provided no evidence that the services were rendered. The defendants also allegedly billed twice for the same services and misrepresented the level of a service provided to increase their reimbursement from the federal health care programs.
“It is critical that federal health care beneficiaries receive care that is properly supervised,” said Stuart F. Delery, Assistant Attorney General for the Justice Department’s Civil Division. “We will continue to pursue companies and individuals that seek to boost their profits at the expense of taxpayers.”
Since December 2007, Sacred Heart Health System Inc. and West Florida Medical Center Clinic P.A. have been the sole shareholders of Gulf Region Radiation Oncology MSO LLC and GRROC. GRROC provides radiation oncology services at two locations in Pensacola, Fla. Sacred Heart was also a shareholder in ECROC, a radiation oncology center located in Destin, Fla., approximately 60 miles from Pensacola. Beginning in December 2007, Lowrey and Krentel, both radiation oncologists, began providing physician services at the GRROC clinics, and in June 2008, they began providing services at ECROC.
“Submitting false claims for medical services raises the cost of health care for all of us as patients and taxpayers,” said Pamela C. Marsh, U.S. Attorney for the Northern District of Florida. “Patients, employees and others who suspect billing fraud on the part of health care providers should not hesitate to report such fraud to federal authorities. Health care providers – both corporations and individuals – must be held accountable when they submit false information.”
The allegations resolved by today’s settlement were first raised in a lawsuit filed against the defendants under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. As part of the settlement, the whistleblower, Richard Koch, who previously worked at GRROC, will receive approximately $609,796 from the federal share of the settlement amount.
In addition to the $3.5 million payment, defendants GRROC, Lowrey and Krentel entered into Integrity Agreements with the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) intended to deter wrongful conduct in the future. The agreements require enhanced accountability and monitoring activities to be conducted by both internal and independent external reviewers.
“Patient care supervision is critical for ensuring that Medicare beneficiaries receive needed, top-quality care,” said Christopher B. Dennis, Special Agent in Charge, HHS-OIG, Office of Investigations, Miami Region. “Our increased investigative efforts in the Florida panhandle show that we will protect taxpayer-funded government health programs regardless of where perpetrators might be located.”
Assistant Attorney General Delery thanked the Department of Health and Human Services’ Office of Inspector General; TRICARE Management Activity; the U.S. Attorney’s Office for the Northern District of Florida and the Justice Department’s Civil Division, Commercial Litigation Branch for the collaboration that resulted in the settlement.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $14.8 billion through False Claims Act cases, with more than $10.8 billion of that amount recovered in cases involving fraud against federal health care programs.
The case is captioned United States ex rel. Koch v. Gulf Region Radiation Oncology Centers Inc., et al., No. 3:12-cv-00504 (N.D. Fla.). The claims settled by this agreement are allegations only, and there has been no determination of liability.