In a recent healthcare fraud settlement, Adventist Health System – Sunbelt Healthcare Corporation has agreed to pay $5.4 million to settle allegations it improperly billed Medicare and Medicaid for radiology services. The settlement concludes an investigation conducted by the U.S. Attorney’s Office for the Middle District of Florida, the Civil Division’s Commercial Litigation Branch, and the U.S. Department of Health and Human Services’ Office of Inspector General. The lawsuit that prompted the investigation was commenced by a Florida-based radiation oncologist and former employee of Florida Oncology Network, P.A., an Adventist Health System participant. In exchange for his willingness to come forward, the whistleblower is set to receive $1,085,100 as a qui tam reward.
Details of the allegations against Adventist
Non-profit health management company Adventist manages a number of hospital chains across the Southeast and Midwest United States. Accordingly, it is required to adhere to the mandates set forth by the Medicare and Medicaid systems when treating enrolled patients. With regard to the performance of radiation oncology services, these programs require direct supervision and involvement by radiation oncologists during each procedure.
According to the allegations set forth by the whistleblower, Adventist would routinely bill Medicare and Medicaid for the full value of oncology radiation despite conducting the procedures outside the presence of a licensed radiation oncologist. This practice not only violated the billing protocols in place, but potentially exposed patients to a heightened risk of danger or injury by not ensuring proper oversight by trained medical professionals.
The misconduct is alleged to have occurred between 2010 and 2013, and was prevalent at its Altamonte Springs, Daytona Beach, Deland, Kissimmee, Orange City, Orlando, Palm Coast, and Winter Park locations.
The procedures involved included “radiation simulation, dosimetry, radiation treatment delivery and devices, and intensity-modulated radiation therapy,” all of which are highly technical medical procedures requiring the expertise and direct involvement of an experienced oncology practitioner.
Government issues a response to the settlement
The U.S. Attorney’s Office said in a statement, “Medicare and TRICARE patients deserve high-quality healthcare….We will not tolerate providers recklessly cutting corners, particularly when furnishing such critical medical services as radiation oncology.”
The Department of Health and Human Services similarly commented, stating, “Providing proper supervision of radiation oncology services is an important requirement in federal healthcare programs such as Medicare….Our agency will continue to hold health care providers accountable for meeting the requirements in these taxpayer-funded programs.”
Contact a reputable whistleblower attorney today
Since 2009, the False Claims Act has shown remarkable success in combating wasteful fraud. Since that time, federal authorities have used this piece of legislation to recover over $15 billion in healthcare fraud settlements and the numbers continue to grow each year.
If you are in the healthcare field and believe your employer may be engaging in unlawful billing or patient service practices, we encourage you to contact Berger Montague right away for assistance with your case.