A dermatologist who filed a whistleblower lawsuit against a Florida dermatology practice alleging it defrauded Medicare and Medicaid has helped the U.S. government recover $4 million.
Dermatology Healthcare, a Tampa-based provider of dermatology care to residents of assisted living facilities, agreed to settle the government’s claims of fraud, which originated with a False Claims Act lawsuit filed by Dr. Theodore A. Schiff, according to an announcement by U.S. Attorney Maria Chapa Lopez.
Dr. Schiff filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging Dermatology Healthcare failed to adequately supervise the administration of superficial radiation therapy to patients.
Dr. Schiff also claimed that the practice “upcoded” claims for superficial radiation therapy services, meaning it billed Medicare and Medicaid more than it should have with billing codes that would reimburse at higher rates.
Additionally, the whistleblower lawsuit alleged that Dermatology Healthcare billed the government health care programs for excessive radiation simulations – the prep work performed on patients before they receive radiation treatments.
According to federal investigators, the practices alleged in the whistleblower lawsuit occurred from 2011 through 2016, resulting in Medicare and Medicaid overpaying Dermatology Healthcare by millions of dollars.
Dr. Schiff will receive between $600,000 and $1.5 million as an award for filing the whistleblower lawsuit. His complaint against Dermatology Healthcare is the second False Claims Act lawsuit he filed against a Florida dermatology practice.
In 2013 and 2014, Dr. Schiff filed whistleblower lawsuits against Water’s Edge Dermatology and its owner Dr. Gary Marder, accusing them of them of engaging in illegal kickback schemes, pocketing tens of millions of dollars from Medicare by ordering medically unnecessary biopsies, falsely diagnosing patients with cancer, performing unnecessary radiation treatments on patients, and illegally billing the government for those biopsies and radiation treatments.
Both complaints subsequently were combined into one False Claims Act lawsuit. The case went to trial and resulted in a February 2017 judgment against the defendants for $18 million – an amount that was later conditionally reduced to $5.2 million based on Dr. Marler’s ability to pay.