Medicare Paid Fort Myers Oncologists Group $20 Million for Procrit in 2012 By Tod Aronovitz | 07/02/14 | 0 Comment

Another Wall Street Journal analysis of Medicare physician-payment data released to the public this April has found there’s a group of oncologists in Fort Myers who prescribe Procrit at higher rates than what has been typical.

The use of the drug Procrit in cancer patients has been decreasing since 2007 when the FDA issued a warning about findings that linked its use to increased stroke risk, tumor growth, and earlier death for cancer patients.

This class of drugs—called erythropoiesis-stimulating agents—was first approved in 1989 for anemia from kidney disease and later for anemia from chemotherapy. Now, oncologists use Procrit and another similar drug, Aranesp, sparingly, only when treatment options determine the benefits outweigh the risks.

According to an article in the Wall Street Journal on June 19, “Cancer Doctors Ring Up Big Medicare Bills for Tarnished Drug Procrit,” the WSJ determined that Medicare reimbursed U.S. oncologists $128 million in 2012 to administer Procrit; but one-sixth of that money went to the Fort Myers group—Florida Cancer Specialists. Furthermore, WSJ research ascertained that out of the top 20 oncologists whom Medicare paid the most for Procrit, 11 were from that Florida Cancer Specialists group.

In the WSJ article, William Harwin, president of Florida Cancer Specialists, said that his group’s use of the drug is “correct medically, and we follow the guidelines” for administering and billing for the treatment. He added that the group has also significantly decreased its use of Procrit since 2007.

He explained the disproportion in findings may be due to regional differences in patients’ health and in what Medicare covers, and that the clinic’s electronic records system helps keep patients on track with their appointments, avoiding missed treatments that might cause other oncologists to under bill.

Dr. Harwin said that the group’s doctors “primarily use Procrit for patients with kidney disease or a rare blood disorder, some of whom also have cancer.”

Although Florida’s rates of cancer and kidney disease are well above the national average, the WSJ reports that Florida Cancer Specialists used Procrit more than other Florida oncologists in the data, despite the fact that many cancer doctors, in addition to many kidney doctors, reined in their use of the drug. Data shows that in 2012, Medicare’s reimbursement for Procrit came to $363 million, plummeting 70% from 2007.

The use of pricey drugs can be profitable, the article revealed, as Medicare pays doctors up to 6% more than an average sales price for drugs that are injectable or infused in-office. In addition, larger practices can get discounts from suppliers that can potentially earn more than the 6% margin.

Substantial Medicare billings go beyond Procrit for Florida Cancer Specialists, the article found. Twenty-eight of its doctors were ranked among the top 100 U.S. oncologists by 2012 Medicare payments for all services. Twenty-two received more than $3 million each from Medicare—which is considered “high cumulative payments” by the inspector general, who recommended in a 2013 report to scrutinize top-paid doctors’ billings.

Dr. Vikas Malhotra was Florida Cancer Specialists’ biggest payee in 2012. He received $8.4 million, including $562,907 for Procrit and was ranked 12th among the highest Medicare payments to any doctor that year. He attributes these results to an increase in the number of his patients, Florida’s high cancer rates, and work done by nurse practitioners. For Procrit use, he says, a high number of blood-disease rates and referrals from kidney specialists account for the data’s results.

According to the article, Medicare doesn’t forbid a doctor from billing for Procrit for kidney disease, even if the patient is being treated for cancer and doesn’t meet Medicare’s anemia threshold for billing for cancer. Some Medicare-billing authorities believe that oncologists will record kidney disease on a Procrit bill to avoid the cancer rules if a patient has both diseases.

However, a Medicare spokesman said in the article, “there are no administrative requirements that require these types of claims to be billed separately. Medicare hasn’t identified issues at the Florida group other than small overpayments the group repaid,” he said.

How to Report Florida 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 between 10 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.