Two California urologists accused of submitting false claims to Medicare and causing other doctors to submit false claims to Medicare have agreed to pay the U.S. government more than $1 million to resolve the allegations.
The U.S. Justice Department (DOJ) said that Dr. Aytac Apaydin and Dr. Stephen Worsham, who own and operate Salinas Valley Urology Associates in Salinas, California, “knowingly caused eight urologists in Monterey and Salinas, California … to violate the Anti-Kickback Statute and the Stark Law” through improper financial arrangements.
The defendants also owned Salinas-based Advance Radiation Oncology Center, California, which dissolved in 2016.
According to the False Claims Act allegations, Dr. Apaydin and Dr. Worsham solicited the eight other urologists to enter into lease agreements with Advance Radiation Oncology and used those leases to facilitate improper Medicare billings. Under the leases, the “lessee” urologists could bill for profit from their referrals of image-guided radiation therapy (IGRT) procedures performed at Advance Radiation Oncology Center.
The DOJ alleged that this arrangement violated the Anti-Kickback Statute, which prohibits offering, paying, soliciting, and receiving payment in any form to induce referrals of goods and services covered by federal health care programs.
The DOJ also alleged that Dr. Apaydin and Dr. Worsham violated the Stark Law by improperly billing Medicare for their own IGRT referrals to Advance Radiation Oncology Center, even though Advance Radiation and Salinas Valley Urology Associates were separate entities and their financial arrangements did not comply with any exceptions to the Stark Law.
The Stark Law bars health care providers from billing Medicare for certain services referred by physicians who have a financial relationship with the entity performing the service unless an exception applies.
The eight urologists who participated in the kickback scheme settled false claims allegations with the U.S government previously, agreeing to collectively pay $900,000.
“Patients who use our federal health care programs deserve care that is free from fraud. The few doctors who choose to engage in this type of conduct not only undermine the system but impugn the many honest and dedicated medical professionals who serve our community,” according to a statement from the DOJ.