Related Federal Cases
Fort Myers Urologist’s $3.8M Scam Exposed
Fort Myers, FL – A Fort Myers urologist has agreed to pay $3.81 million to the government to resolve allegations that he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary.
Meir Daller, M.D., a urologist practicing as part of Gulfstream Urology, a division of 21st Century Oncology, LLC, submitted claims to Medicare and Tricare for fluorescence in situ hybridization (FISH) tests that were not medically necessary, according to the allegations. FISH tests are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer.
The settlement announced today resolves allegations that Dr. Daller submitted claims for FISH tests that were not reasonable or necessary. Medicare does not consider a FISH test reasonable or necessary unless it is used to monitor for tumor reoccurrence in a patient previously diagnosed with bladder cancer or unless, after performing a full urologic workup, the physician has reason to suspect that a patient with hematuria (i.e., blood in the urine) may have bladder cancer.
Beginning in 2009, Dr. Daller began referring all of the FISH testing ordered by him to a laboratory owned and operated by 21st Century. During the relevant time, Dr. Daller ordered over 13,000 separate FISH tests on his Medicare patients, making him the number one referring physician in the country with respect to FISH tests. Dr. Daller was paid bonuses by the company based, in part, on the number of FISH tests he referred to 21st Century laboratory. During the relevant time, Dr. Daller received approximately $2 million in bonus payments from 21st Century associated with these FISH tests.
The allegations that doctors affiliated with 21st Century were ordering unnecessary FISH tests were originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act. The original lawsuit was captioned United States, State of Florida, ex rel. Mariela Barnes v. Dr. David Spellberg, 21st Century Oncology and Naples Urology Associates, Civil Action No. 2:13-cv-228-FtM-38DNF (M.D. Fla.).
In addition to the civil settlement, Dr. Daller has entered into a three-year Integrity Agreement with the Office of Inspector General of the United States Department of Health and Human Services. The Integrity Agreement, among other obligations, requires Dr. Daller to retain an Independent Review Organization to perform a Claims Review, as well as an Electronic Health Records Review to evaluate the appropriateness of any revisions made to the medical record after initial entry, pursuant to Medicare and Medicaid requirements.
The whistleblower, a former medical assistant who worked for David Spellberg, M.D. at Naples Urology Associates, will receive $571,500 as her share of this recovery. This amount is in addition to a $3,437,000 share she already received as a result of the settlements previously reached with David Spellberg, M.D., Robert Scappa, D.O., and 21st Century Oncology. The United States’ total recovery relating to the investigation of the use of FISH tests by doctors affiliated with 21st Century is now $24,860,000.
Key Facts
- State: Florida
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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