Medicare requires that many procedures provided by healthcare facilities be directly overseen or observed by a physician. When this does not occur, the patient is at risk of receiving inadequate care and Medicare will not consider those services eligible for reimbursement. When a facility falsely represents that a physician did oversee a procedure when one did not, things get more complicated.
According to the Department of Justice, a number of facilities in the Gulf Coast were improperly billing Medicare, Medicaid and Tricare for oncology services. These facilities included: Sacred Heart Health System Inc., West Florida Medical Center Clinic P.A., Gulf Regional Radiation Oncology Centers Inc., Gulf Radiation Oncology MSO LLC, Emerald Coast Radiation Oncology Center LLC, Dr . Gerald Lowrey and Dr. Rod Krentel.
“Medicare pays for billions of dollars’ worth of medical treatment in the United States every year,” commented Christopher Paulos, an attorney with the Levin, Papantonio law firm who practices in the areas of qui tam or whistleblower and False Claims Act litigation. “Facilities that abuse the program make it harder for patients to obtain the care they need.”
The $3.5 million settlement resolves allegations that were originally filed under the qui tam provisions of the False Claims Act by Richard Koch, formerly employed by Gulf Coast Radiation Oncology Centers Inc. Mr. Koch came forward with his knowledge of the institutions’ practices and filed a lawsuit to recover for the falsely submitted claims on behalf of the government. For his efforts, Mr. Koch will receive almost $610,000 from the settlement.
“Unfortunately, exploitation of the Medicare system and government reimbursement often goes without notice,” Mr. Paulos continued. “Without the brave actions of whistleblowers like Mr. Koch, the government would be left footing the bill for millions in False claims. The False Claims Act provides tools and protection to individuals like Mr. Koch to come forward, expose corruption, and be rewarded for their actions.”
Joshua is a writer and researcher with Ring of Fire.