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Oncologist Sentenced in Medicare Drug Scam

John Commins, for HealthLeaders Media, July 26, 2011

An Orange County, CA oncologist was sentenced to 18 months in federal prison Monday for bilking Medicare and other public and private health insurance providers for up to $1 million for injectable cancer medications that were never provided, the Department of Justice said.

Glen R. Justice, MD, who ran Pacific Coast Hematology/Oncology Medical Group in Fountain Valley, CA, pleaded guilty in May 2010 to five counts of healthcare fraud, DOJ said in a media release.

When patients did receive medications, Justice "upcoded" claims made to health insurance providers by falsely claiming that he administered more expensive injectable medications than were actually given to patients, DOJ said.

The medications involved in the scheme included Neulasta, Neupogen, Procrit/Epogen/Aranesp, and Neumega. Justice's scheme ran from at least 2004 through October 2009, despite being told by staff about the improper billing and the execution of a search warrant at his practice in 2006, DOJ said.

In a plea agreement Justice, 66, acknowledged that the public and private health insurance providers – including Medicare, Tricare, carriers contracted with the federal government through the Federal Employee Health Benefit Program, and Blue Cross and Blue Shield of California – suffered losses of between $400,000 and $1 million, DOJ said.

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