Radiation oncologist Todd J. Scarbrough, MD, and Melbourne (FL) Internal Medicine Associates (MIMA) P.A. will pay the federal government $12 million to settle whistleblower allegations that they submitted false claims to Medicare and TRICARE, the Justice Department said.
MIMA operates clinics in Brevard County, FL, and Scarbrough was the medical director and practicing radiation oncologist at one of them, the MIMA Cancer Center in Melbourne.
In the complaint filed last October, federal prosecutors said the cancer center and Scarbrough improperly billed for radiation oncology services and submitted false claims to Medicare and TRICARE.
DOJ said its investigation revealed that the MIMA Cancer Center inflated claims through various schemes designed to cloak the fraud. In particular, MIMA Cancer Center billed for services not supervised, duplicate and unnecessary services, services not rendered, and upcoded services. DOJ said MIMA executives knew about the scam, but failed to stop it.
"Healthcare providers must be held accountable for their billing practices," said A. Brian Albritton, U.S. attorney for the Middle District of Florida. "Those who submit false claims will be sought out and in the end they will pay dearly for their fraudulent claims."
MIMA issued a statement acknowledging the settlement, but said it was not necessarily an admission of guilt. "Please keep in mind that we settled this matter rather than sustain lengthy, costly, complex litigation. The government and MIMA have agreed to a cash settlement and procedural clarifications. The understanding is that we still have deep disagreements about allegations made by the government. For our part, MIMA is relieved to have this resolved so we can now move on," the statement said.
The settlement resolves a False Claims Act whistleblower lawsuit filed by Fred Fangman, former director of radiation oncology at MIMA Cancer Center, who will receive $2.64 million of the settlement.
The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion, said DOJ.