A group of radiation oncology providers based in Pensacola, Florida have agreed to pay $3.5 million to settle allegations of false claims brought under the qui tam, or whistleblower, provisions of the False Claims Act according to a DoJ press release.  Richard Koch, a former employee of Gulf Regional Radiation Oncology Centers, Inc. (GRROC), filed the suit in 2012, naming GRROC, Gulf Region Radiation Oncology MSO LLC, Sacred Heart Health System, Inc., West Florida Medical Center Clinic P.A., Emerald Coast Radiation Oncology Center LLC (ECROC), Dr. Gerald Lowrey and Dr. Rod Krentel as defendants.

The suit alleges that between 2007 and 2011 the defendants regularly billed Medicare, Medicaid and TRICARE for radiation oncology services that were not eligible for payment.  Koch alleges that (1) many services were not supervised by a physician, as required by regulation, (2) defendants billed for services that were not indicated in the patients’ charts, (3) defendants billed for some services multiple times, and (4) defendants misrepresented the level of service provided in order to increase their reimbursement rate from Medicare, Medicaid and TRICARE.

“Submitting false claims for medical services raises the cost of healthcare for all of us as patients and taxpayers,” said Pamela C. Marsh, U.S. Attorney for the Northern District of Florida.  “Patients, employees, and other who suspect billing fraud on the part of the healthcare providers should not hesitate to report such fraud to federal authorities.  Healthcare providers – both corporations and individuals – must be held accountable when they submit false information.”

The defendants have agreed to pay $3.5 million to the federal government and the state of Florida.  In addition, GRROC, Lowery and Krentel have entered into Integrity Agreements with the Government which require enhanced accountability and monitoring activities be conducted by internal and external reviewers.  As a result of the settlement, Richard Koch will receive approximately $609,796 from the federal share of the settlement.

To report healthcare fraud, please contact Frohsin & Barger.