Cancer Care Provider Settles Medicaid Billing Claims

     WASHINGTON (CN) – The nation’s largest integrated cancer care provider will pay $34.7 million to settle claims from the federal government over improper Medicaid billing, the U.S. Department of Justice announced Tuesday.
     Fort Myers, Fla. based 21st Century Oncology Inc. and its wholly-owned subsidiary South Florida Radiation Oncology LLC agreed to settle allegations that they performed and billed for procedures that weren’t medically necessary.
     The United States claimed the defendants improperly billed for a procedure known as the Gamma function where it served no medical purpose. The Gamma function measures the exit dose of radiation from a patient after receiving radiation treatment.
     The government’s claims included that the procedure was performed by physicians and physicists who were not properly trained to interpret and utilize the Gamma function results, the defendants billed for this procedure when no physician reviewed the results until seven or more days after the last day patients received radiation therapy and that the defendants billed for the procedure when no result was available due to technical failures in the imaging equipment.
     “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. “Providers who waste taxpayer dollars by billing for unnecessary services, including services that are not used or improperly performed, will face serious consequences.”
     Joseph Ting, a former physicist at South Florida Radiation Oncology will receive more than $7 million of the recovery under the whistleblower provisions of the False Claims Act.
     It is the second large settlement involving 21st Century Oncology Inc. in recent months.
     This past December, 21st Century Oncology LLC, a wholly owned subsidiary of 21st Century Oncology Inc., paid $19.75 million to settle allegations that it violated the False Claims Act by billing for medically unnecessary laboratory urine tests and for encouraging physicians to order these tests by offering bonuses.
     The claims resolved by this settlement are allegations only and there has been no determination of liability.

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