On January 19, the United States Attorney of the Eastern District of New York, Breon Peace, announced that New York Presbyterian Hospital (NYPH) reached an $800,000 settlement over allegations brought under the qui tam provision of the False Claims Act (FCA). A qui tam whistleblower spurred an investigation that found that two radiology practices, Radiation Therapist Associates, P.C. (RTA) and Leading Edge Radiation Oncology Services, PLLC (LEROS), allegedly inaccurately billed and defrauded Medicare, Medicaid, and TRICARE.
Qui tam is a provision under the FCA that incentivizes whistleblowers to file a report on behalf of the United States government by rewarding 15-30% of the government sanctions once a settlement of monetary arrangement is agreed upon. Since 1986, the False Claims Act has led to $7.3 billion in whistleblower rewards.
According to the government, “between 2012 and 2018, RTA and LEROS billed for images utilized in IGRT when such images were either not reviewed, or were not timely reviewed, and therefore were not reasonable and necessary”.
RTA and LEROS, the two radiology practices, supplied an outpatient radiation oncology service called IGRT to treat cancer patients. The IGRT provides images that allow for direct screening of the area that contains cancerous cells, allowing for accurate radiation treatment of cancer. Investigations found that, allegedly, RTA was overbilling the government more than the appropriate amount for these services, ultimately defrauding healthcare programs.
“The defendants provided substandard care to cancer patients by not properly or timely reviewing medical imaging and then billed taxpayer funded healthcare programs for these shoddy services,” stated Peace.
The government further noted that “NYPH will pay a total of $801,000, with $694,999.71 going to the United States and $106,000.29 to the State of New York”.
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”
Kohn sees the passage of the False Claims Amendments Act as one of the seven most urgently needed whistleblower reforms. National Whistleblower Center (NWC), where Kohn serves as Chairman of the Board, has issued an Action Alert calling on Congress to pass the bill.