Seven radiation oncology providers in Pensacola, FL, are settling allegations of improper Medicaid, Medicare and TRICARE billing, and are set to pay a collective $3.5 million to the state and federal governments.
The U.S. Department of Justice said that the providers as far back as 2007 "regularly billed for radiation oncology services that were not supervised by a physician," as the public payer programs require, and that some of the doctors were on vacation while the radiation therapy was administered at their clinics.
DOJ also alleged that Gulf Region Radiation Oncology Centers, Sacred Heart Health System, and West Florida Medical Center Clinic sometimes billed for treatments "even when patients' medical records provided no evidence that the services were rendered," and "misrepresented the level of a service provided to increase their reimbursement."
In 2007, Sacred Heart Health System, a member of the non-profit Ascension Health, and West Florida Medical Center Clinic, a large outpatient speciality provider, joined as shareholders of Gulf Region Radiation Oncology, eventually with Gerald Lowrey, MD, and Rod Krentel, MD, contracted to practice at several clinics throughout greater Pensacola.
DOJ's investigation and lawsuit stemmed from whistleblower complaint filed by Richard Koch, a former employee of Gulf Region Radio Oncology.
Koch said he was hired to merge the operations of the radiation clinics in 2009, and noticed that the doctors weren't always supervising radiation therapy services provided at their clinics. Koch is receiving about $609,000 from the federal share of the $3.5 million settlement.