Cancer care services provider 21st Century Oncology LLC has agreed to pay the U.S. $19.75 million to resolve allegations brought by a whistleblower that it violated the False Claims Act by billing federal health care programs for laboratory tests that were not medically necessary.
The U.S. Justice Department said on Friday that a former 21st Century Oncology medical assistant filed the whistleblower complaint. The Justice Department chose to actively participate in prosecuting the claims after federal authorities investigated the whistleblower’s allegations.
According to federal prosecutors, 21st Century submitted false claims to Medicare and Tricare for fluorescence in situ hybridization, also known as “FISH” tests, which analyze urine for genetic abnormalities that are associated with the presence of bladder cancer.
The whistleblower complaint asserted that 21st Century Oncology awarded bonuses to four urologists who practiced in the company’s home city of Fort Myers, Fla. Those bonuses were tied to the number of FISH tests the physicians referred to 21st Century, which encouraged them to order tests that were medically unneeded. 21st Century billed the government health care programs for the tests.
“Charging the government for clearly unnecessary medical services squanders taxpayer dollars,” U.S. Attorney A. Lee Bentley, III of the Middle District of Florida, said in a statement. “Our office will continue to pursue health care providers who defraud the United States, thereby threatening the viability of government health care programs, such as Medicare.”
“These tests were ordered to increase profits, not improve the healthcare of patients,” said Department of Health and Human Services Special Agent Shimon Richmond. “This kind of unvarnished fraud is an attack on Medicare by unscrupulous providers and the OIG and its federal partners will take whatever steps are necessary to stop them.”
Whisteleblowers who sue on behalf of the U.S. government for the recovery of taxpayer funds are awarded up to 30 percent of any funds recovered as a result of their case. The former 21st Century Oncology employee who filed the False Claims Act complaint has been awarded $3.2 million as her share for her role in the case.
Source: U.S. Department of Justice