Florida oncologist, practice pay $12 million to settle whistleblower False Claims Act case

by Ben Vernia | March 23rd, 2010

In a March 23 announcement, the Department of Justice stated that Dr. Todd Scarborough and the medical practice of which he is medical director, Melbourne Internal Medical Associates, are paying $12 million to settle claims brought by a qui tam whistleblower. According to the Department:

MIMA provides health care services through a network of facilities located in Brevard County, Fla. Dr. Scarbrough was the medical director and practicing radiation oncologist at one of those facilities, the MIMA Cancer Center in Melbourne, Fla. In the complaint filed on Oct. 16, 2009, the United States alleged that, from the time of its inception through 2008, the MIMA Cancer Center, led by Dr. Scarbrough, improperly billed for certain radiation oncology services and caused false and fraudulent claims to be submitted to Medicare and TRICARE.

The United States’ investigation revealed that the MIMA Cancer Center had defrauded the federal health care programs by improperly inflating claims through various schemes specifically designed to cloak the fraudulent practices. In particular, the MIMA Cancer Center billed for services not supervised, duplicate and unnecessary services, services not rendered and upcoded services – a practice in which provider services are billed for higher procedure codes than were actually performed. The United States’ investigation found that MIMA executives had knowledge of a substantial number of the fraudulent billing practices at the facility, but had failed to stop the fraudulent billing.

The whistleblower is the practice’s former director of radiation oncology, who will receive $2.64 million of the recovery. The sum – 22% of the total – is a high percentage for a case in which the US intervened. The False Claims Act provides that relators in such cases will receive between 15% and 25% of the settlement or judgment.

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