by Ben Vernia | September 14th, 2013
On September 13, the Department of Justice announced that doctors, hospitals and clinics in Pensacola, Florida, had agreed to pay a combined $3.5 million to resolve charges initially filed by a whistleblower that they defrauded Medicare, Medicaid, and TRICARE (the Department of Defense health insurance program). According to DOJ’s press release:
Radiation oncology providers in Pensacola, Fla., will pay $3.5 million to the government and the state of Florida to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment, the Justice Department announced today. The defendants include Gulf Region Radiation Oncology Centers Inc. (GRROC), Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Dr. Gerald Lowrey and Dr. Rod Krentel.
The government alleged that between 2007 and 2011, the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE, and that, in fact, these services were often performed while the defendant doctors were on vacation or were working at another radiation oncology clinic. The government also alleged that the defendants billed for other treatment services even when patients’ medical records provided no evidence that the services were rendered. The defendants also allegedly billed twice for the same services and misrepresented the level of a service provided to increase their reimbursement from the federal health care programs.
Since December 2007, Sacred Heart Health System Inc. and West Florida Medical Center Clinic P.A. have been the sole shareholders of Gulf Region Radiation Oncology MSO LLC and GRROC. GRROC provides radiation oncology services at two locations in Pensacola, Fla. Sacred Heart was also a shareholder in ECROC, a radiation oncology center located in Destin, Fla., approximately 60 miles from Pensacola. Beginning in December 2007, Lowrey and Krentel, both radiation oncologists, began providing physician services at the GRROC clinics, and in June 2008, they began providing services at ECROC.
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In addition to the $3.5 million payment, defendants GRROC, Lowrey and Krentel entered into Integrity Agreements with the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) intended to deter wrongful conduct in the future. The agreements require enhanced accountability and monitoring activities to be conducted by both internal and independent external reviewers.
The qui tam relator, a former employee of one of the oncology centers, will receive $609,796 (a 17.4% relator’s share), DOJ announced.