Kusserow on Compliance: DOJ settles with 21st Century Oncology for almost $20M

21st Century Oncology LLC, has agreed to pay $19.75 million to the government to resolve allegations that it violated the False Claims Act (FCA) by billing federal health care programs for laboratory tests that were not medically necessary, the Justice Department announced today. 21st Century is a nationwide provider of integrated cancer care services that is headquartered in Fort Myers, Florida. The settlement resolves allegations that 21st Century submitted claims to Medicare and TRICARE for tests that were not medically necessary. The case was originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the FCA. The whistleblower, a former 21st Century Oncology LLC medical assistant, will receive $3.2 million as her share of the recovery in this case.

This settlement was cited by the DOJ as another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative by the Attorney General and the Secretary of HHS. Since its initiation in January 2009, the Justice Department has recovered a total of more than $26.7 billion through FCA cases, with more than $16.8 billion of that amount recovered in cases involving fraud against federal health care programs.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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