Baylor University rad onc settlement

[Werg]

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For those of you who feel that healthcare can be a legal minefield, here's some more fodder for you...

Baylor University Medical Center will pay $907,355 to settle whistleblower allegations that it submitted false claims for radiation oncology services, including intensity modulated radiation therapy.

http://www.corporatecrimereporter.com/news/200/baylorfalseclaims11272012/


Here are links to the federal complaints against Baylor University Med Center / Texas Oncology that were recently unsealed(?):

http://www.corporatecrimereporter.com/wp-content/uploads/2012/11/baylor.pdf
http://www.corporatecrimereporter.com/wp-content/uploads/2012/11/baylor2.pdf

Looks like the complaints centered on issues of supervision (rad onc not on site), billing fraud, and rad oncs violating the Stark law (self-referral).

 

[lazers]

FYI baylor university medical center located in dallas(doesn't have a residency program) is a completely separate entity as Baylor college of medicine (does have a residency program)

 

[seper]

The amount settled is low - compare that to recent Atlanta case. Baylor whistle-blowers won't get much, and will have trouble finding jobs again.

 

[medgator]

The amount settled is low - compare that to recent Atlanta case. Baylor whistle-blowers won't get much, and will have trouble finding jobs again.

Yup.... under a million. I've seen settlements 10x or more that amount in recent years. Btw, I've heard of people finding jobs again. Sounds like the smart thing to do is to get settled with a new job before bringing the lawsuit. It sounds like the MDs weren't present during SRS (GK and CK) cases. Definitely egregious:

"It was this last allegation – high dose radiation treatment without physician supervision – that appeared to be driving the litigation."

It never hurts to review the ASTRO white paper and the medicare FAQ on MD supervision in rad onc:

https://www.astro.org/uploadedFiles...agement/Reimbursement/Medicare/SVFAQs0210.pdf
https://www.astro.org/uploadedFiles...t/Reimbursement/Medicare/SVReqsUpdate6211.pdf

 

[OTN]

FYI, Texas Oncology was completely exonerated and paid no fines to the gov't.

 

[medgator]

Bigger than baylor it sounds like....

Fla. Oncologists Pay $3.5M To Settle Medicare Fraud Claims

Law360, New York (September 16, 2013, 2:53 PM ET) -- A group of Florida radiation oncology service providers has settled a whistleblower lawsuit with the federal government for $3.5 million, the U.S. Department of Justice announced Monday, ending the case alleging that they defrauded Medicare and Medicaid by performing unnecessary and improperly supervised procedures.

The False Claims Act suit accused Pensacola-based Gulf Region Radiation Oncology Centers Inc. and doctors Gerald Lowrey and Rod Krentel of billing Medicare, Medicaid, the U.S. Department of Veterans Affairs and military health system Tricare for "unreasonable, unnecessary or medically improper radiation diagnosis and treatments" and of submitting false claims to the insurance systems.

In addition to the cash, Monday’s settlement requires the defendants to sign integrity agreements with the U.S. Department of Health and Human Services that the government says will deter wrongful conduct in the future. The agreements require enhanced accountability and monitoring activities, the Justice Department said in a statement.

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

The two physicians allegedly didn't supervise or perform procedures that require medical supervision and had "medically unnecessary procedures and testing" performed, including dosimetry calculations and "other radiation oncology tests and procedures."

The federal complaint said the government paid at least $3.5 million as a result of the alleged fraud between December 2007 and October 2011 and asked for treble damages under the False Claims Act, plus a civil penalty between $5,000 and $10,000 for each of about 6,450 claims.

 

[Gfunk6]

There are SOOOO many Rad Onc practices where "physicians [don't] supervise or perform procedures that require medical supervision." All it takes is one whistle-blower . . . .

 

[medgator]

There are SOOOO many Rad Onc practices where "physicians [don't] supervise or perform procedures that require medical supervision." All it takes is one whistle-blower . . . .

Yup, although the sunshine state seems overly well represented in that regard