A medical assistant at a cancer-care practice in Fort Myers, Florida collected $3.2 million when the practice settled a False Claims Act case for nearly $20 million.
Mariela Barnes worked for 21st Century Oncology LLC. She filed a whistleblower suit in March 2013 alleging the firm submitted Medicare and other government claims for medically unnecessary tests.
The DOJ said the tests were ordered by four Fort Myers-based urologists — Dr. David Spellberg, Dr. Meir Daller, Dr. Steven Paletsky, and Dr. Robert Scappa.
Under the whistleblower provisions of the False Claims Act, private parties can bring qui tam lawsuits on behalf of the government and share in any recovery. The government has the option to take over qui tam suits, as it did in this case.
The DOJ alleged that 21st Century encouraged the doctors to order unnecessary tests by offering bonuses based in part on the number of tests referred to 21st Century’s laboratory.
The settlement resolved the civil liability of 21st Century only, the DOJ said.
The DOJ’s Benjamin Mizer said, “Providers who waste taxpayer dollars by billing for unnecessary services will face serious consequences.”
The case was 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.).
The claims resolved by the settlement were allegations only and there has been no determination of liability, the DOJ said.
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Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.
1 Comment
Very interesting and useful news … To think about it and discuss . First thing is that attitude with whistleblowers is different across the culture : exam prescription has different regulation from one place to another, as sick people needs . According to public finance problems and deficit, it is crucial not to do test without specific aim either to overprescribe, especially if the intention is not medical… People can also ask about the impact of this announcement on medical doctors and patients attitude: when what is doing is to much? What is the price of health for an individual ? And open the discussion. for example : What difference between the "in office" private attitude in the face to face relationship and the global health regulation and what are the limits? Conversely, this is particularly true and difficult to argue in preventive medicine. Doing blood , radiological test makes us and the insurances more confident for future , but the discover of small preclinical diseases could have an impact on people mental health, bad feelings. So, to do or not to do is not a simple question for medical testing . Annaik Feve is neurologist, MD, PHD and head of Neurofinde , specialized in control, regulation and compliance in public and private administrations with a neuroscientist mind
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