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Local Hospitals, Doctors To Pay $3.5 Million For Improper Billing
September 14, 2013
Radiation oncology providers in Pensacola will pay $3.5 million to the government and the state of Florida to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment, the Justice Department announced late Friday.
The defendants include Gulf Region Radiation Oncology Centers Inc. (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.
The government alleged that between 2007 and 2011, the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE, and that, in fact, these services were often performed while the defendant doctors were on vacation or were working at another radiation oncology clinic. The government also alleged that the defendants billed for other treatment services even when patients’ medical records provided no evidence that the services were rendered. The defendants also allegedly billed twice for the same services and misrepresented the level of a service provided to increase their reimbursement from the federal health care programs.
“It is critical that federal health care beneficiaries receive care that is properly supervised,” said Stuart F. Delery, Assistant Attorney General for the Justice Department’s Civil Division. “We will continue to pursue companies and individuals that seek to boost their profits at the expense of taxpayers.”
Since December 2007, Sacred Heart Health System Inc. and West Florida Medical Center Clinic P.A. have been the sole shareholders of Gulf Region Radiation Oncology MSO LLC and GRROC. GRROC provides radiation oncology services at two locations in Pensacola. Sacred Heart was also a shareholder in ECROC, a radiation oncology center located in Destin, Fla., approximately 60 miles from Pensacola. Beginning in December 2007, Lowrey and Krentel, both radiation oncologists, began providing physician services at the GRROC clinics, and in June 2008, they began providing services at ECROC.
“Submitting false claims for medical services raises the cost of health care for all of us as patients and taxpayers,” said Pamela C. Marsh, U.S. Attorney for the Northern District of Florida. “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 allegations resolved by today’s settlement were first raised in a lawsuit filed against the defendants under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. As part of the settlement, the whistleblower, Richard Koch, who previously worked at GRROC, will receive approximately $609,796 from the federal share of the settlement amount.
In addition to the $3.5 million payment, defendants GRROC, Lowrey and Krentel entered into Integrity Agreements with the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) intended to deter wrongful conduct in the future. The agreements require enhanced accountability and monitoring activities to be conducted by both internal and independent external reviewers.
“Patient care supervision is critical for ensuring that Medicare beneficiaries receive needed, top-quality care,” said Christopher B. Dennis, Special Agent in Charge, HHS-OIG, Office of Investigations, Miami Region. “Our increased investigative efforts in the Florida panhandle show that we will protect taxpayer-funded government health programs regardless of where perpetrators might be located.”
Comments
13 Responses to “Local Hospitals, Doctors To Pay $3.5 Million For Improper Billing”
@jane & @CSR: look at the report. It wasn’t just about coding and billing. the doctors billed for supervising services when they weren’t even there! TWO doctors supervising THREE clinics, over 60 miles apart. The whistleblower was fired because he tried to correct the problem and they would not agree to it. When he could not correct it in-house, he resorted to the law.
It seems like the providers are a bigger problem when it comes to Medicare and Medicaid than the patients are. Something our governor knows a little something about. How much was your company fined for that Medicare fraud when you were running, Rick? Two billion dollars, wasn’t it? That’s a whole lot of fraud. Enough for you to take the 5th 75 times, at any rate.
It usually isn’t the doctors fault…it is due to the way they code and bill. Blame the people who put in the codes and do the billing without checking to see if it is correct. Yes, there are some accidental errors, but sometimes it is just the way the system is set up that causes the problems.
…private practices and care the best in the world? only if one can afford it…and the private practices doing anything it can to make money…kind of like the way for-profit organizations look at diseases and illnesses…they really dont have the motivation to “cure” anything…if they do they will lose money and “go out of business” they make money by treating it than curing it…so in this aspect, why do people want this sort of “care”? while more socialized medicine is willing to find cures just to it’ll be cheaper for society?
Dr. Krentel was over my mothers radiation treatments we loved him and he was a nice guy we were completely shocked by all this he was nothing butb professional.
My loved one starts their cancer treatment there next week. Dr. Lowery and all the staff have been very professional and kind to us.
Before blaming these doctors you all need to take the time to understand just who is actually responsible for what happened. The so called whistleblower that is making a large amount of money that you believed has done such a great thing was the former administrator of GRROC and was over the billing aspect of the office. He was fired from that position. If you think that any of your doctors are responsible directly for the billing part of their business you are badly mistaken. All doctors depend on their administration and billing personnel to do the right thing. Sounds like easy money for Richard “whistleblower” Cook. A rat loves cheese. BTW This was not his first rodeo. I feel for Dr Lowery who is a great Dr who cares about his patients.f
Glad this was found out and resolved. Don’t guess it is enough to get any one of the people elected governor. Rick Scott’s company was fined more than 2 BILLION. And fines are usually settled for about 10%.
This was all brought to light by an ex employee of one of the places named. The”whistleblower” will get a reward of $750,000. Not a bad payment for doing the right thing.
As a vet. I am glad they got caught! I kept getting a bill from##$@! and had to fight to get it fixed. When I finally got it fixed it saved me $400.00 and piece of mind. To any vet who has a concern contact a vet . administer and get them to help you. The Pensacola V.A. has a lot of great people.
This doesn’t surprise me. Several years ago I questioned some hospital bills that I knew couldn’t be right and the hospital changed the bill. I took some time but it saved $3000. Sometimes you have to really look at what you are billed for and ask questions.
Far more money to be made treating cancer as opposed to curing it.
Thanks. Great job