Orlando, FL – Acting United States Attorney Karin Hoppmann announces today that the Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay the United States $3.4 million to resolve allegations that both companies violated the False Claims Act by submitting claims for kidney stone procedures that were not medically justified and for engaging in an illegal kickback arrangement.
The United States previously intervened in a whistleblower lawsuit against SCA and the Orlando Center on October 15, 2019. The lawsuit and settlement relate to the submission of claims for extracorporeal shock wave lithotripsy, a procedure used to break up kidney stones. According to the lawsuit, Dr. Patrick Hunter was a urologist who performed lithotripsy procedures at the Orlando Center, a facility affiliated with SCA. According to the settlement agreement, between January 2010 and April of 2016, the Orlando Center submitted claims for lithotripsy procedures performed on Medicare and TRICARE patients by Dr. Hunter that were medically unnecessary because the procedures were not medically indicated or because the patients did not have kidney stones.
The settlement agreement also resolves allegations that Dr. Hunter, SCA, and the Orlando Center engaged in an illegal kickback arrangement, where Dr. Hunter performed the lithotripsy procedures in exchange for per-procedure payments from the Orlando Center. Dr. Hunter allegedly agreed to perform his lithotripsy procedures at the Orlando Center in exchange for payments from the Orlando Center, in violation of the Anti-Kickback Statute. SCA vetted and approved the agreement. These procedures were then billed to and paid by Medicare and TRICARE in violation of the False Claims Act.
“Medicare and TRICARE patients are some of our most vulnerable populations,” said Acting U.S. Attorney Karin Hoppmann. “The United States Attorney’s Office will always pursue providers who seek and pay illegal kickbacks or bill for baseless procedures.”
“My office remains steadfast in our commitment to address illegal kickback arrangements within the federal healthcare system,” said Special Agent in Charge Omar Pérez Aybar of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “We will continue to work with our law enforcement partners to hold accountable individuals and entities who pay or receive kickbacks.”
“We owe it to our beneficiaries to ensure their needs are placed first and the commitment to their care is unwavering. Any time the government is defrauded, it is unacceptable to the American taxpayer, and in this case, Medicare also was a victim. We are grateful to the Department of Justice for working to maintain trust and transparency by ensuring medical providers continue to put their patients’ needs first,” said Defense Health Agency Director, Lt. Gen. Ronald J. Place, M.D.
The settlement resulted from a lawsuit originally filed in the United States District Court for the Middle District of Florida by Scott Thompson. Mr. Thompson sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. The United States intervened in this matter and litigated the case. Mr. Thompson will receive $748,000 of the proceeds from the settlement with SCA and the Orlando Center.
Dr. Hunter passed away in March of 2019. In November 2020, Dr. Hunter’s estate paid the United States $1.75 million to resolve the government’s claims arising from Dr. Hunter’s alleged participation in the scheme.
The United States’ intervention in and settlement of this matter illustrates its emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
This settlement resulted from a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, the HHS Office of Inspector General, and the Defense Health Agency. Assistant United States Attorneys Jeremy R. Bloor and Sean Keefe led the investigation.
The case is captioned United States ex rel. Thompson v. Surgical Care Affiliates et al., Case No. 6:16-cv-2189-PGB-LRH. The settlement resolves the United States’ claims against SCA and the Orlando Center in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.