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Target Tumors, Not Yourself: A Review of False Claims Act Allegations Against Radiation Oncologists

June 2, 2015 - Applied Radiation Oncology
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by John McCaffrey and Anthony Mastroianni, JD, MBA, MD

The Department of Justice is investigating radiation oncology service providers. Why? In the words of the infamous American bank robber Willie Sutton, “because that’s where the money is.” Last year, the Centers for Medicare & Medicaid Services (CMS) disclosed the amounts paid to physicians, and radiation oncologists were among the top recipients of federal monies.Each year, CMS pays hundreds of millions in radiation oncology claims, which steadily rise with the growing use of complex and costly radiation treatments secondary to rapidly evolving technologies. As a result, the Department of Justice and plaintiff attorneys have pursued lawsuits against radiation oncology providers with claims of fraud, abuse and waste.

This article provides an overview of the federal False Claims Act and discusses specific legal actions pursued against radiation oncology providers under the False Claims Act, either by the Department of Justice, a qui tam relator (one who brings an action on the government’s behalf), or both. Most importantly, it examines the specific misconduct identified as actionable, and highlights common sense practices to avoid being named as a False Claims Act defendant, particularly when developing cost-containment strategies. Read the article here.

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