On September 30, 2013, a press release was issued announcing that a lawsuit filed on behalf of the United States against Winter Park Urology Associates, P.A., Radiation Oncology Consultants, P.A., and three of the latter’s physicians – Steven G. Lester, M.D., John D. Looper, M.D., and Maneesh Gossain, M.D. – has been settled. The qui tam lawsuit was filed by Carlo Santa Ana on May 19, 2010, against the aforementioned defendants in the United States District Court for the Middle District of Florida. It alleges that they presented false or fraudulent claims for payment to federal healthcare programs and used false records to present these claims. As alleged, the false and fraudulent claims amounted to more than $20 million.
Winter Park Urology Associates is a physician-owned practice located in Orlando, Florida. It operates the Orlando Cancer Institute. Radiation Oncology Consultants, P.A., through three of its physicians—Dr. Lester, Dr. Looper, and Dr. Gossain—supervised the administration and operation of the Orlando Cancer Institute. From June 2008 through March 2010, Mr. Santa Ana was the Director of Medical Physics for the Orlando Cancer Institute. Mr. Santa Ana was also Department Manager for the Orlando Cancer Institute from April 2009 through March 2010. He was terminated by Winter Park Urology Associates in March 2010.
The Complaint alleges that the Orlando Cancer Institute submitted thousands of claims for image-guided radiation therapy and intensity modulated radiation therapy, despite the fact that the therapy was performed without a supervising physician, as required for reimbursement by Medicare. Specifically, the Complaint sets forth that radiation therapists performed services and read image-guided radiation therapy images without any involvement from a radiation oncologist. Images were not reviewed by a radiation oncologist until long after treatment was provided, if at all, based on allegations in the Complaint. According to the Complaint, Orlando Cancer Institute also submitted claims for intensity modulated radiation therapy that were not medically necessary.
The Complaint further alleges that Orlando Cancer Institute developed a policy of submitting add-on claims for special procedures, which such procedures were almost never adequately justified. These procedures included medical radiation physics consultations and special treatment procedures.
In addition, the Complaint claims that Winter Park Urology Associates violated the Florida Patient Self-Referral Act, which prohibits a physician from referring to entities in which the referring physician holds an interest, subject to certain exceptions. The violations occurred when Winter Park Urology Associates referred patients to the Orlando Cancer Center. Finally, the Complaint alleges that Winter Park Urology Associates retaliated against Mr. Santa Ana by terminating him due to his complaints about the wrongdoing alleged in the Complaint.
Radiation Oncology Consultants, Dr. Lester, Dr. Looper, and Dr. Gossain were dismissed from the lawsuit as part of the settlement. Winter Park Urology Associates has agreed to settle the matter, but the financial details of the settlement have not yet been made public. The United States Department of Justice will have to approve the terms of the settlement agreement before it can be finalized.
If you are an employee and find yourself in a situation in which you have been retaliated against for complaints about practices by your employer, Barrett Law PLLC, can help you understand your rights and the protections to which you may be entitled. We have a long history of protecting the rights of whistleblowers, and intend to continue protecting the rights of whistleblowers into the future. Contact us today at (601) 790-1505 to schedule an initial consultation.
