21st Century Oncology to pay $26 million to settle False Claims Act allegations
Staff Writer |
21st Century Oncology and certain of its subsidiaries and affiliates have agreed to pay $26 million to the government.
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They will pay to resolve a self-disclosure relating to the submission of false attestations regarding the company’s use of electronic health records software and separate allegations that they violated the False Claims Act by submitting, or causing the submission of, claims for certain services provided pursuant to referrals from physicians with whom they had improper financial relationships.
21st Century Oncology, which is headquartered in Fort Myers, Florida, owns and operates subsidiaries and affiliates throughout the United States that provide integrated cancer care. As part of its business, 21st Century Oncology’s subsidiaries and affiliates employ physicians in specialty fields such as radiation oncology, medical oncology, and urology.
The settlement resolves conduct that was self-disclosed by the company regarding payments made by the government as part of the Medicare Electronic Health Records (EHR) Incentive Program.
Under the Medicare EHR Incentive Program, physicians who attest to their meaningful use of certified EHR technology may receive incentive payments and avoid downward adjustments to certain Medicare claims.
As part of its self-disclosure, 21st Century Oncology reported that it knowingly submitted, or caused the submission of, false attestations to CMS concerning employed physicians’ use of EHR software.
The company further reported that, in support of the attestations, its employees falsified data regarding the company’s use of EHR software, fabricated software utilization reports, and superimposed EHR vendor logos onto the reports to make them look legitimate.
The settlement also resolves the government’s allegations regarding violations of the physician self-referral law (commonly referred to as the “Stark Law.â€)
The Stark Law prohibits an entity from submitting claims to Medicare for designated health services performed pursuant to referrals from physicians with whom the entity has a financial relationship unless certain designated exceptions apply.
The government alleged that 21st Century Oncology and certain of its subsidiaries and affiliates violated the FCA by submitting, or causing the submission of, claims for services performed pursuant to referrals from physicians whose compensation did not satisfy any exception to the Stark Law.
The Stark Law allegations were originally brought in a lawsuit filed by Matthew Moore, 21st Century Oncology’s former Interim Vice President of Financial Planning, under the qui tam provisions of the False Claims Act. Under the Act, private parties may bring suit on behalf of the government and share in any recovery.
Mr. Moore will receive $2,000,000 as his share of the recovery associated with the Stark Law allegations.
In addition to the civil settlement, 21st Century Oncology has entered into a new five-year Corporate Integrity Agreement with the Office of Inspector General of the United States Department of Health and Human Services (HHS-OIG), which obligates 21st Century Oncology to undertake substantial internal compliance reforms, including hiring independent review organizations to conduct annual claims and arrangements reviews. ■