- 21st Century Oncology reached a settlement with the Department of Justice to resolve allegations that the healthcare organization submitted false or inflated meaningful use attestations.
The $26 million settlement will also resolve separate allegations that the provider violated the False Claims Act by submitting or enabling the submission of claims that involved kickbacks for physician referrals.
“The Justice Department is committed to zealously investigating improper financial relationships that have the potential to compromise physicians’ medical judgment,” said Acting Assistant Attorney General Chad A. Readler. “However, we will work with companies that accept responsibility for their past compliance failures and promptly take corrective action.”
The Florida-based healthcare organization owns and operates subsidiaries and affiliates across the country dedicated to providing integrated cancer care. The organization also provides radiation oncology, medical oncology, and urology services.
The settlement resolves self-disclosed allegations about claims the provider submitted to falsely acquire federal payments through the EHR Incentive Programs. 21st Century Oncology reported that it knowingly submitted or enabled the submission of false attestations to CMS about its physicians’ EHR use in order to earn incentive payments and avoid downward payment adjustments as a result of meaningful use requirements.
Additionally, the healthcare organization reported its employees falsified data about the organization’s EHR use, fabricated EHR use reports, and superimposed EHR vendor logos onto false reports to make them look legitimate.
“This settlement represents our office’s continued commitment to ensuring compliance with important federal health care laws,” said Middle District of Florida Acting U.S. Attorney Stephen Muldrow. “We appreciate that 21st Century Oncology self-reported a major fraud affecting Medicare, and we are also pleased that the company has agreed to accept financial responsibility for past compliance failures.”
The report released by the Department of Justice also revealed that the settlement will resolve allegations from the government claiming 21st Century Oncology violated the physician self-referral law known as the Stark Law.
“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,” clarified the Department of Justice in its report.
The government claimed the healthcare organization violated The Stark Law and the False Claims Act by submitting claims for services created by referrals from physicians with a financial relationship with 21st Century Oncology.
In addition to paying a multimillion-dollar settlement, 21st Century Oncology has agreed to enter into a five-year Corporate Integrity Agreement with the Office of Inspector General (OIG). The agreement mandates that 21st Century Oncology will undertake substantial internal compliance reforms and hire an independent review organization to conduct annual claims and arrangement reviews.
“21st Century Oncology admitted to causing violation of the meaningful use regulations in order to fund an electronic health records system, as well as falsifying records to cover up those actions,” said OIG Special Agent in Charge Shimon R. Richmond “Separately, the government alleged that same company, through its affiliates and subsidiaries, caused certain physicians to enter into illegal financial arrangements. Providers engaging in similar behavior should expect attention from OIG.”
The Department of Justice stated the settlement should serve as an example of the government’s commitment to combatting healthcare fraud.
This settlement marks the second bout of allegations related to healthcare kickback schemes in a month.
In November, 62 Indiana hospitals were sued in a federal civil lawsuit for allegedly falsifying records and participating in a kickback scheme by overbilling for the release of patient EHRs.
Court documents revealed the hospitals allegedly made false claims to defraud taxpayers of more than $300 million. Prosecuting attorneys in the case are seeking damages that could exceed $1 billion.