21st Century and South Florida Radiation Oncology Centers Under Scrutiny for Medicare Billing By Tod Aronovitz | 11/20/14 | 0 Comment

For the second time this year, the U.S. Department of Justice is looking into 21st Century Oncology Holdings Inc. for its use of certain medical procedures and how they have been billed to Medicare.

According to a November 13 Wall Street Journal article, “Cancer-Care Giant Is Investigated Over Medicare Billing” by John Carreyrou, a second round of accusations involve 21st Century allegedly billing for services related to radiation treatments that were medically unnecessary or not provided.

The company disclosed its first round of allegations in May, which involve an investigation into a curiously high number of Medicare billings for an expensive bladder-cancer test.  Both are civil investigations.

Based in Fort Myers, 21st Century Oncology holds a variety of cancer centers throughout 16 states.  Last year’s revenues totaled $646 million—55% of which stemmed from Medicare billings. The network of centers concentrates their focus on radiation therapy, which can cost Medicare up to $30,000 in reimbursements per case, the article reported.

In February, the company also acquired majority ownership of South Florida Radiation Oncology (SFRO), which has a variety of locations throughout Florida including Miami, and is at the center of these latest allegations.

A press release issued by the company and filed with the SEC said that there were two Civil Investigative Demands (CIDs)—one addressed to 21st Century on October 22 and one to SFRO on October 31 pursuant to the False Claims Act.  The CIDs request information pertaining to allegations that both companies illegally billed Medicare for services from January 1, 2009 to present.

At the center of SFRO’s investigation is a radiation program called “Gamma,” which the clinic had been using before the acquisition. It involves measuring the amount of radiation patients receive during treatment, supposedly to ensure that it matches the treatment plan. Constantine Mantz, 21st Century’s chief medical officer, contends that Gamma can help improve patient care because tumors can change size and shape during the course of treatment requiring adjustments to the radiation beam.

There is strong debate, however, as to the necessity of Gamma.  Others believe there are enough other quality assurance measures in place even before a patient’s treatment begins. David Beyer, a radiation oncologist and president-elect of the American Society for Radiation Oncology, said that the Gamma program is not a typical practice in other cancer centers.

An ongoing series by the WSJ has been scrutinizing Medicare physician-payment data released to the public this April.  The newspaper’s analysis includes examination of 21st Century Oncology. According to the WSJ, the company collected nearly $10 million for the Gamma procedure in 2012—16% of what Medicare paid out nationwide to non-hospital providers. In addition, 18 of the 20 doctors who billed Medicare the most for the procedure in 2012 were 21st Century Oncology employees.

A regulatory filing by the company made earlier this year in anticipation of an initial public offering of stock predicted that Gamma would contribute to “over $7 million of annual synergies,” the article reported.  However, the IPO was cancelled this summer.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.