The biggest doctor-led cancer care provider in the United States and a Florida subsidiary paid $34.7 million Tuesday to resolve whistleblower allegations they performed and billed for procedures that weren’t medically necessary.
21st Century Oncology Inc. is headquartered in Fort Myers, Florida and has offices in 16 states.
The whistleblower filed a lawsuit under the qui tam provisions of the False Claims Act. The FCA allows private parties to sue on behalf of the United States and receive a portion of the recovery.
The court awarded Joseph Ting, a former physicist at the Florida subsidiary, more than $7 million.
Ting alleged that 21st Century and South Florida Radiation Oncology used a medical procedure — called the Gamma function — to measure the exit dose of radiation from patients after they received radiation treatment.
The defendants “knowingly and improperly billed for this procedure under circumstances where the procedure served no medically appropriate purpose,” the DOJ said Tuesday.
The suit alleged that doctors at some 21st Century Oncology locations weren’t properly trained to interpret and apply the Gamma function results.
But the company allegedly billed Medicare and other government programs for the procedure even when no doctor reviewed the results, or reviewed them a week or more after the end of patients’ radiation treatments.
In December, a 21st Century Oncology subsidiary paid $19.75 million to settle another False Claims Act lawsuit.
The suit alleged the company billed for medically unnecessary laboratory urine tests, and encouraged doctors to order the tests by offering illegal bonuses.
The whistleblower in that case — Mariela Barnes, a medical assistant at a cancer-care practice in Fort Myers, Florida — collected $3.2 million.
The DOJ said Tuesday the claims resolved by the latest settlement were allegations only and there was no determination of liability.
The lawsuit in the U.S. District Court for the Middle District of Florida was United States ex rel. Ting v. 21st Century Oncology and South Florida Radiation Oncology.
Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.