For the second time, 21st Century Oncology, has agreed to pay millions to settle a case that focused on Medicare fraud. The U.S. Department of Justice settled with the Fort Myers, Florida, company in December 2015 in order to take care of allegations that the bladder-cancer tests Medicare patients underwent were not needed as frequently as ordered.
A new allegation surfaced after a medical physicist filed a complaint in 2014 over a violation of the False Claims Act. Abraham Lincoln signed this law in 1853, which made it illegal for anyone to deceive our nation's government for financial gain. In that act, there is a provision that allows whistleblowers who prevail in their complaint to receive part of the proceeds. The physicist will get over $7 million from 21st Century Oncology's settlement with the DOJ.
The physicist alleged that 21st Century Oncology started a "Gamma" analysis program. This program performs tests on patients diagnosed with cancer before doctors even knew how to interpret the test results. In some instances, the physicist alleged that there might not have been any findings at all from the tests because of a technical error -- but Medicare was billed anyway.
The attorney for the physicist said, "Dr. [physicist] showed tremendous heroism when he stepped forward to ensure that doctors, not automated processes, oversee patient care. As practices modernize, all healthcare workers must be mindful that machines serve medicine -- not vice versa."
Whistleblowers are also protected from retaliation from their employers under the False Claims Act. If you are aware of illegal activities occurring at your place of work, an employment law attorney can provide information on your legal options.
Source: South Florida Reporter, "Medicare Fraud Whistleblower Wins $34.7 Million Settlement," Mark Young, March 13, 2016