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
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
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.