ONCOLOGY COMPANY TO PAY OVER $2 MILLION TO SETTLE FALSE MEDICARE CLAIMS ALLEGATIONS

FROM:  U.S. JUSTICE DEPARTMENT
Thursday, November 21, 2013
Vantage Oncology LLC to Pay More Than $2.08 Million for False Medicare Claims for Radiation Oncology Services

Vantage Oncology LLC (Vantage) has agreed to pay the government more than $2.08 million to settle allegations that it submitted false claims to Medicare for radiation oncology services performed at its Illinois centers from 2007 through June 2012, the Justice Department announced today.  Vantage owns and manages radiation oncology centers in multiple states, including two centers in Spring Valley and Streator, Ill.
                                                         
“Billing Medicare for patient care that is not necessary or appropriate contributes to the soaring costs of health care,” said Assistant Attorney General for the Civil Division Stuart F. Delery.  “The Department of Justice is committed to protecting public funds and guarding against abuse of the Medicare system.”

The government alleged that Vantage double billed and overbilled Medicare for certain procedures, billed for services that lacked supporting documentation and improperly billed for radiation treatment provided to patients without proper physician supervision.

“Our office remains committed to ensuring appropriate patient care and protecting the integrity of government insurance programs,” said U.S. Attorney for the Southern District of Ohio C arter M. Stewart .

“Cheating taxpayers by double billing, overbilling and wrongly billing for services without required medical oversight will not be tolerated,” said Special Agent in Charge with the Office of Inspector General of the U.S. Department of Health and Human Services Lamont Pugh III.  “The Office of Inspector General is committed to identifying, investigating and holding accountable those who improperly profit at the expense of the Medicare program.”

This settlement resolves a lawsuit filed by former Vantage employee Suleiman Refaei under the qui tam, or whistleblower, provisions of the False Claims Act.  The Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery.  Refaei will receive $354,450.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $16.7 billion through False Claims Act cases, with more than $11.9 billion of that amount recovered in cases involving fraud against federal health care programs.

The investigation was jointly handled by the U.S. Attorney’s Office for the Southern District of Ohio; the Justice Department’s Civil Division, Commercial Litigation Branch and the Department of Health and Human Services Office of the Inspector General.

The case is captioned United States ex rel. Suleiman Refaei v. Vantage Oncology, et al., Case No. 1:10-cv-833 (S.D. Ohio).  The claims resolved by the settlement are allegations only, and there has been no determination of liability.