Insurance Fraud NEWS
Cancer providers accused of illegal patient referrals
August 17, 2017, Fort Myers, FL
Two of the nation’s largest cancer-care providers are accused of engaging in an illegal “gentleman’s agreement” to divide up treatment services in Florida.
The allegation against Florida Cancer Specialists & Research Institute and 21st Century Oncology lists multiple claims — gender discrimination, fraudulent Medicare billing and unsafe medical practices — against the companies in a 50-page federal whistleblower lawsuit filed last year that had, until recently, been under seal and out of the public eye.
According to the lawsuit, Florida Cancer Specialists and 21st Century Oncology paid “millions of dollars to each other in the form of exclusive patient referrals in order to secure their individual monopolies in Southwest Florida of medical oncology (Florida Cancer Specialists) and radiation oncology (21st Century Oncology).”
The lawsuit was brought by Sharon Dill, Florida Cancer Specialists vice president for human resources and chief human resources officer from 2012 to 2015, and Christina Sievert, the company’s vice president of clinical financial services 2013 to 2015.
Both say they were fired. Dill claims she lost her job after disclosing an unspecified disability. Sievert said the company retaliated against her when she claimed gender discrimination.
Benjamin Yormak, the attorney for Dill and Sievert, said his clients have company documents to back up their claims.
“They were privy to a number of wrongdoings," Yormak said. "If you look at the services 21st Century provides and Florida Cancer on a national basis or through the state of Florida, you'll notice that they should be direct competitors. If you look at the services offered, say, from Sarasota-Bradenton to Marco (Island), you'll notice that there's not competition between them."
Florida Cancer Specialists treats patients throughout Florida. On the Gulf Coast, it has centers from Tampa Bay to Naples. Harwin operates out of a $8.5 million office the company opened last year on Gladiolus Drive in south Fort Myers.
Fort Myers-based 21 Century Oncology operated 179 treatment centers, including 143 centers in 17 states. It has another 36 centers in seven Latin American countries.
Kyle Cohen, an assistant U.S. Attorney in Fort Myers who has been involved with recent federal whistleblower investigations involving 21st Century Oncology, said the Department of Justice decided several months ago not to intervene in the civil case for now.
Cohen would not comment when asked if a criminal investigation is underway. But, in a recent legal notice, 21st Century Oncology acknowledged that a federal inquiry into "certain potential criminal antitrust violations regarding the market in Florida" is underway.
Dr. William Harwin, the founder and president of Florida Cancer Specialists, and Dr. Daniel Dosoretz, the founder and former CEO of 21st Century Oncology, are also named as defendants.
A representative of 21st Century Oncology, which filed for Chapter 11 bankruptcy protection in May and settled two federal investigations into fraudulent billing for $54.5 million, said on Wednesday that the company does not comment on pending litigation.
Harwin also said little Wednesday morning: "I'd love to comment, but unfortunately I've been told not to comment. I really wish I could speak. I'd love to."
The company's chief legal officer, Tom Clark, released a more formal written statement:
“At Florida Cancer Specialists, we are focused on providing the best care to our patients and are committed to complying with all the rules and regulations that govern medical centers across the state. The government declined to intervene in this case. We take these allegations seriously and are looking into the matter.”
The lawsuit also claims that Florida Cancer Specialists used under-trained medical assistants to service patients’ surgically implanted catheters, known as MediPorts, which are used to administer medications.
This happened, the suit claims, over the objections of some staffers who worried this may not be safe.
“Accessing a patient’s surgically implanted Mediport dramatically exceeds the level of care and services that a medical assistant is authorized to perform under Florida law,” the lawsuit states. But, it continues, the company required that over the last six years “at most, if not all (Florida Cancer Specialists) clinic locations in the State of Florida. This was corporate policy.”
Yormak said it is still unclear if patients suffered medical harm as a result, though investigators are looking into it.
Dill and Sievert also accuse Florida Cancer Specialists of administering Feraheme, an expensive intravenous prescription drug used to treat iron-deficiency anemia in adults with chronic kidney disease, to some patients who did not need it.
The company commonly treats patients with anemia related to their chemotherapy, the lawsuit states, but that anemia does not necessarily indicate chronic kidney disease.
Because of Medicare reimbursement rates for the drugs, and the discounts the company received from drug suppliers, Florida Cancer Specialists' prescribing of the drug was especially profitable.
The lawsuit claims that company leadership knew that the drug was being unnecessarily prescribed and encouraged it for years.
Publicly operated Lee Health, Southwest Florida's largest hospital system, leases space to both companies at the Regional Cancer Center in Fort Myers and provides some cancer treatment to their patients.
Lee Health is not listed in the lawsuit, and its representatives did not comment on it Wednesday.
Source: USA Today