Healthcare News & Insights

Whistleblower case costs facility more than $900,000

Rather than incur the costs and publicity of a lengthy whistleblower lawsuit, Baylor University Medical Center agreed to pay the federal government $907,355 to settle allegations that it submitted false claims to Medicare for radiation oncology services.

The lawsuit, which also involved Baylor Health Care System and HealthTexas Provider Network, was brought about by Dr. Brian Berger, a radiation oncologist at Baylor, and Janice Delp, a radiation therapist at Baylor. After allegations of submitting false claims to Medicare were ignored by Baylor executives, the two healthcare professionals took their complaints to the government, which joined the lawsuit.

Government allegations

The government alleges that from 2006 through May 2010 Baylor submitted improper claims to Medicare in which the facility:

  • double billed Medicare for several procedures affiliated with radiation treatment plans
  • billed for certain high reimbursement radiation oncology services when a different, less expensive service should have been billed
  • billed for procedures without supporting documentation in the medical record, and
  • improperly billed for radiation treatment delivery without corroboration of physician supervision.

It’s also alleged that Baylor submitted false claims to the Civilian Health and Medical Program of Uniformed Services (TRICARE) and the Federal Employees Health Benefit Program (FEHBP) for various radiation oncology services, including intensity modulated radiation therapy, which is a sophisticated radiation treatment for specific types of cancer where extreme precision is required.

Whistleblower allegations denied

Baylor officials denied the allegations, maintaining that Baylor always provided appropriate physician supervision, according to Dallasnews.com.

And in an email to Baylorlariat.com, Craig Civale, the spokesman for the Baylor University Medical Center, wrote, “The issue involved a disagreement with the Department of Justice on the adequacy of some of our billing records at the Radiosurgery Center Department at Baylor University Medical Center. To avoid protracted and expensive litigation, Baylor has paid the DOJ $907,355 to settle this issue. We are pleased that the matter is concluded.”

Note: Dr. Berger and Delp will receive a portion of the settlement. And while the amount wasn’t disclosed in the agreement, typically it’s 15% to 25% of the settlement when the government is involved.

 

 

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