21st Century Oncology to pay $34.7 million to settle Medicare fraud lawsuit involving Florida offices

MANATEE -- Fort Myers-based 21st Century Oncology, which has offices in Manatee County, has agreed to pay nearly $34.7 million to the United States government to settle a Medicare fraud lawsuit claiming it performed and billed for radiation procedures that were not medically necessary.

The lawsuit was brought against the nation's leading provider of cancer care services by a whistle-blower named Joseph Ting, a former physicist at South Florida Radiation Oncology, according to a news release Tuesday from United States Attorney A. Lee Bentley, III.

The settlement relates to 21st Century Oncology's use of a medical procedure -- called the Gamma function -- used to measure the exit dose radiating from a patient after the patient receives radiation treatment, the release states.

The United States alleged 21st Century Oncology knowingly and improperly billed for this procedure under circumstances where the procedure served no medically appropriate purpose.

For example, the government alleged the procedure was performed by physicians and physicists at 21st Century Oncology locations who were not properly trained to interpret and utilize the Gamma function results.

"The waste of health care program dollars will not be tolerated," said Shimon R. Richmond, special agent in charge for the Office of the Inspector General. "Providers at 21st Century Oncology have agreed to settle claims

that in some instances they performed tests that were not only medically unnecessary, but that no one had been trained to properly interpret, thereby allegedly causing the taxpayers to pay for useless tests."

Under the provisions of the whistle-blower guidelines, a private party can file an action on behalf of the United States and receive a portion of the recovery. Ting will receive more than $7 million, the release states.

In a statement released Tuesday, 21st Century Oncology said it fully cooperated with federal officials and has agreed to the settlement with no admission of wrongdoing.

"The dispute involved the training protocols of certain staff in the utilization of GAMMA, and was limited to its early implementation and startup activities at new facility locations across the country," the statement said. "The company implemented GAMMA across all centers to ensure every patient had access to this technology."

The statement defined the GAMMA function as: "A state-of-the art radiation dose calculation system developed by 21st Century Oncology and implemented by our physicians to optimize patient outcomes."

Since the lawsuit, 21st Century Oncology has improved its compliance, auditing and training programs to ensure transparency, the statement said.

"Only those services that meet the complex Medicare and Medicaid billing criteria are submitted for reimbursement," the statement adds.

The company says there was no harm to any patient related to this dispute.

In December, 21st Century paid $19.75 million to settle allegations it violated the False Claims Act by billing for medically unnecessary laboratory urine tests, and for encouraging physicians to order these tests by offering bonuses based in part on the number of tests the physicians referred to its laboratory.

Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.

This story was originally published March 8, 2016 at 11:54 PM with the headline "21st Century Oncology to pay $34.7 million to settle Medicare fraud lawsuit involving Florida offices ."