If you submit claims for kidney stone procedures that were not medically justified, you are committing an offense. As well, engaging in such an action for the purpose of obtaining a kickback is illegal. It is alleged that the Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP perpetrated these actions. To resolve allegations that it violated the False Claims Act, it has agreed to pay the United States $3.4 million.
As reported by the Middle District of Florida branch of the United States Department of Justice, SCA and the Orlando Center were previously investigated by the United States in a whistleblower lawsuit. This was back on October 15, 2019. The lawsuit and its settlement were in relation to the submission of claims for extracorporeal shock wave lithotripsy. This is a procedure that is used to break up kidney stones.
The lawsuit focused on Dr. Patrick Hunter.
He was an urologist who performed lithotripsy procedures at the Orlando Center. According to the settlement agreement, the Orlando Center submitted claims for lithotripsy procedures performed on Medicare and TRICARE patients between January 2010 and April of 2016.
These procedures were conducted by Dr. Hunter. However, they were considered medically unnecessary either because they were not medically indicated or because the patients did not have any kidney stones.
The settlement agreement was announced this past Monday.
It was made by Acting United States Attorney Karin Hoppmann. “Medicare and TRICARE patients are some of our most vulnerable populations,” she is quoted as saying, “The United States Attorney’s Office will always pursue providers who seek and pay illegal kickbacks or bill for baseless procedures.”
The settlement also resolves allegations that Dr. Hunter, SCA and the Orlando Center engaged in an illegal kickback arrangement. As part of the scheme, Dr. Hunter performed the lithotripsy procedures in exchange for per-procedure payments from the Orlando Center.
“Dr. Hunter allegedly agreed to perform his lithotripsy procedures at the Orlando Center in exchange for payments from the Orlando Center, in violation of the Anti-Kickback Statute,” the DoJ report details, “SCA vetted and approved the agreement. These procedures were then billed to and paid by Medicare and TRICARE in violation of the False Claims Act.”
Dr. Hunter passed away in March of 2019.
The DoJ notes that, in November 2020, his estate paid the United States $1.75 million. This was to resolve claims that arose from the doctor’s alleged participation in the scheme. The lawsuit that resulted in the settlement was originally filed by Scott Thompson.
“Mr. Thompson sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery,” informs the DoJ, “The Act also allows the United States to intervene and prosecute the action. The United States intervened in this matter and litigated the case. Mr. Thompson will receive $748,000 of the proceeds from the settlement with SCA and the Orlando Center.”
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