True or false: The deceased are not responsible for acts of health care fraud. Well, if you’ve closely examined the title of this week’s blog, you’ll know that it’s the latter. As reported by the Middle District of Florida branch of the United States Department of Justice last week, the Estate of Dr. Patrick T. Hunter has agreed to pay the United States $1.75 million. The payment is to resolve allegations that the deceased physician violated the False Claims Act.
Dr. Hunter passed away in March of 2019.
However, as the DoJ reports, between January 2010 and April 2016, Dr. Hunter is alleged to have submitted claims for Extracorporeal Shock Wave Lithotripsy (ESWL) - a kidney stone procedure - that were not medically justified. He is also accused of engaging in an illegal kickback arrangement during that stretch of time.
As explained by the National Kidney Foundation, ESWL is the most common treatment for kidney stones in the United States. “Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment,” they detail, “The stones are broken into tiny pieces.”
Dr. Hunter is alleged to have performed lithotripsy procedures on Medicare and TRICARE patients that were medically unnecessary. This is because the procedures were either not medically indicated or there were no kidney stones in those patients.
The settlement agreement also resolves illegal kickback allegations.
The DoJ reports that Dr. Hunter engaged in an illegal kickback arrangement with the Orlando Center for Outpatient Surgery, LP. It is there where he performed the lithotripsy procedures. Allegedly, Dr. Hunter and the Orlando Center entered into an agreement where the urologist would perform his lithotripsy procedures at the facility.
In exchange, he would receive payments from the Orlando Center, in violation of the Anti-Kickback Statute. The procedures were then billed to and paid by Medicare and TRICARE. This was in violation of the False Claims Act.
The settlement resulted from a lawsuit 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,” reports the DoJ, “The Act also allows the United States to intervene and prosecute the action. Mr. Thompson will receive $385,000 of the proceeds from the settlement with Dr. Hunter’s Estate.”
United States Attorney Maria Chapa Lopez made the announcement about the posthumous settlement last Friday. “Physicians that perform illegal and baseless procedures violate the sanctity of the doctor-patient relationship,” she is quoted as saying in the DoJ report, “The U.S. Attorney’s Office remains committed to pursuing providers who perform unnecessary procedures and engage in illegal kickback agreements that violate the law.”
Our team can help you in the battle against fraud.
At Allegiant Experts, we coordinate and support courageous whistleblowers who shine lights on fraud, waste and abuse. We also consult with and educate attorneys that fight against wrongful billing practices that negatively impact both individuals and the larger healthcare industry. In addition, we mentor healthcare delivery agencies that just want to get their billing right.
If you could use our help, let’s schedule your complimentary consultation today! Please don’t hesitate to call us at 407-217-5831 or email us at info@allegiantexperts.com.