21st Century Oncology, Medicare Fraud, Florida 2023

21st Century Oncology Inc., the nation’s largest physician-led integrated cancer care provider and its wholly owned subsidiary South Florida Radiation Oncology LLC, have agreed to settle allegations that they performed and billed for procedures that were not medically necessary, the government announced today.

According to the government, 21st Century Oncology knowingly and improperly billed for a medical procedure called the Gamma function, which measures the exit dose of radiation from a patient after receiving radiation treatment. The procedure was performed by physicians and physicists who were not properly trained to interpret and utilize the results, and the company billed for it even when no physician reviewed the results until seven or more days after the last day patients received radiation treatment therapy.

The government alleged that the defendants also billed for the procedure when no Gamma result was available due to technical failures in the imaging equipment. “Today’s settlement demonstrates our unwavering commitment to protect the Medicare trust fund against unscrupulous providers,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “Providers who waste taxpayer dollars by billing for unnecessary services, including services that are not used or improperly performed, will face serious consequences.”

The U.S. Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud, said U.S. Attorney A. Lee Bentley III for the Middle District of Florida. “Healthcare providers may bill for new technologies only when they have been proven to be useful and when individual physicians and staff have been trained to use them properly.”

This lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act by Joseph Ting, a former physicist at South Florida Radiation Oncology. Under those provisions, a private party, known as a relator, can file an action on behalf of the United States and receive a portion of the recovery. Ting will receive more than $7 million.

21st Century Oncology has a history of Medicare fraud, having paid $19.75 million in December to settle allegations that it violated the False Claims Act by billing for medically unnecessary laboratory urine tests. The company’s latest settlement marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius.

The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. The government’s emphasis on combating health care fraud is clear, and companies like 21st Century Oncology will continue to face serious consequences for their actions.”

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