The University of Maryland Shore Regional Health will pay $296,870 to settle allegations that it violated the False Claims Act. The case stemmed from J. Phillip Sawyer’s qui tam whistleblower lawsuit filed under the False Claims Act; as a whistleblower award, Sawyer will receive $51,952.
Shore Health “is a part of the University of Maryland Medical System,” and the press release published by the U.S. Attorney’s Office for the District of Maryland states that Shore Health serves residents in five Maryland counties. According to the settlement agreement, “from January 16, 2014 through July 5, 2018, Shore Health billed Medicare for radiation therapy and diagnostic services.” In that duration of time, “Medicare covered radiation therapy and diagnostic services furnished in an outpatient setting when rendered under the direct supervision of a physician.” The term “direct supervision” means “that the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure.” However, “direct supervision” doesn’t “mean that the physician must be present in the room when the procedure is performed.”
“At all relevant times, Shore Health had only one physician, John Mastandrea, M.D., available to supervise radiation therapy and diagnostic services,” the press release states. This settlement “resolves allegations that on many occasions, Dr. Mastandrea was performing uninterruptible radiation oncology services at a separate location while unsupervised radiation therapy and diagnostic services were being performed at Shore Health.”
J. Phillip Sawyer, the whistleblower in the case, formerly worked for Shore Health. He filed a qui tam lawsuit to lodge his allegations. The qui tam provisions of the False Claims Act enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs. The federal government also has the option to join in a qui tam lawsuit.
Whistleblowers are key to uncovering fraud, corruption, and misconduct in the healthcare industry. In Fiscal Year 2021, whistleblowers helped the DOJ recover $1.6 billion in settlements.
The DOJ reported that “[o]f the more than $5.6 billion in settlements and judgments” that the agency reported in FY2021, “over $5 billion relates to matters that involved the health care industry.”
After the initial publication of this article, a spokesperson for UM Shore Regional Health released the following statement to WNN: “University of Maryland Shore Regional Health takes the responsibility of caring for our communities very seriously. The organization acted in good faith in interpreting the Centers for Medicare & Medicaid Services physician supervision guidelines in place at the time, and found that no patient harm resulted from this practice. CMS has since relaxed the supervision regulations at issue in this matter.”
