JACKSONVILLE, Fla. (Mar. 8, 2016) — Fort Myers-based 21st Century Oncology must pay a $34.7 million settlement in a Medicare fraud case related to allegations of routine billing of the U.S. government for services that were not medically necessary or valuable to its patients, according to documents released today by the U.S. Department of Justice.
The settlement was based largely on information provided by whistleblower Joseph Y. Ting, Ph.D., an experienced medical physicist. “We cannot tolerate abuse of Medicare dollars,” said Dr. Ting. “Unnecessary tests interfere with good medical counsel and drain Medicare’s limited resources.”
Dr. Ting resigned shortly after the company acquired his then-employer, South Florida Radiation Oncology. At that time, 21st Century Oncology implemented a “Gamma” analysis program which, according to Dr. Ting’s amended complaint, automatically performed tests on cancer patients before doctors and therapists were trained to interpret results. According to Dr. Ting’s allegations, it is unclear if the tests were ordered, or if the results were reviewed by doctors. In some cases, according to Dr. Ting, a technical error may have prevented the tests, which were billed to Medicare, from delivering any findings at all.
“Dr. Ting resigned his employment because 21st Century Oncology turned a blind eye to the flaws in the automated process. The company prioritized profit over medical counsel,” said David L. Scher, a principal of The Employment Law Group® law firm and lead attorney on the case. “Dr. Ting stayed focused on providing quality patient care.”
“Dr. Ting showed tremendous heroism when he stepped forward to ensure that doctors, not automated processes, oversee patient care,” said R. Scott Oswald, managing principal of The Employment Law Group. “As practices modernize, all healthcare workers must be mindful that machines serve medicine — not vice versa.”
The settlement with 21st Century Oncology was coordinated by the U.S. Attorney’s Office for the Middle District of Florida. “When medical decision-making is influenced by significant financial incentives, patients suffer — and, in this case, patients and taxpayers were bilked for a test of questionable validity that the government contends, in some cases, offered no value or meaning to any healthcare practitioners,” said Jason Mehta, Assistant U.S. Attorney.
To report the Medicare abuse he witnessed, Dr. Ting filed a complaint in 2014 against 21st Century Oncology under the False Claims Act (FCA), a federal law originally signed by Abraham Lincoln in 1863. The FCA makes it illegal to deceive the federal government for financial gain; it includes a “qui tam” provision that allows whistleblowers to file a legal complaint on behalf of the government and — if they prevail — to receive a share of the proceeds. Dr. Ting will receive more than $7 million from the settlement.
21st Century Oncology has faced other allegations of Medicare fraud. In December 2015 the cancer-care giant agreed to pay $19.75 million to settle a case with the U.S. Department of Justice to resolve allegations that it violated the FCA regarding the unnecessary frequency of bladder-cancer tests performed on Medicare patients. The company withdrew a scheduled initial public offering on January 5, 2016.