Win-Win Situation

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Pills spilling out of a prescription bottle on 100 dollar paper currency

One of the most typical ways providers commit medical billing fraud is by charging for services not provided. Thanks to a retired health care consultant and former administrator who blew the whistle on a Los Angeles-based cancer institute, allegations that the company defrauded public health care programs have been settled. (As a result, the whistleblower is now a fairly rich man for bringing these allegations to the government’s attention.)

The hematology and oncology practice, which is based in the Mid-Wilshire area of Los Angeles, and its owner agreed to pay the United States and the State of California a sum of $3,356,565 to settle False Claims Act allegations that the practice billed government healthcare programs for oncology drugs and services that were not provided to patients. (That would be considered healthcare fraud. Good thing they paid up.)

It was alleged that the medical office that specializes in treating cancer patients by prescribing, dispensing, infusing and administering oncology drugs billed Medicare and Medi-Cal – California’s Medicaid program – for the cost of the drugs, infusion costs and administering the drugs to their patients. (That’s all well and good, except the cancer institute didn’t provide the services they claimed. Although, Medicare and Medi-Cal paid as if they did.)

The press release states that the suspicious billing practices occurred for nearly three years as false claims were submitted to the healthcare programs for payment. Those drugs were never bought, dispensed or administered. (It would be interesting to know if anyone’s health suffered from the illegal billing practices. Hopefully not.)

The Medicare program will receive $2,377,675.51 from the defendants while the State of California will be paid $978,907.49. Lucky for the cancer institute, the Department of Health and Human Services agreed to enter into an integrity agreement. (Let’s hope this organization and its owner now knows what integrity is all about.)

It looks like all parties benefited from the win-win situation. The owner of the California-based medical practice isn’t doing any time behind bars for the alleged healthcare fraud while the whistleblower will receive more than $475,000 from the federal government for simply telling the truth. (Like I’ve always said, telling the truth really does pay off in the end.) Just as an FYI, the claims resolved by the settlement are allegations only. No determination of liability was made.

Today’s Fraud of the Day comes from the Department of Justice press release, “Mid-Wilshire Cancer Doctor and His Medical Office Agree to Pay Over $3 Million to Settle Claims They Defrauded Medicare and Medi-Cal,” published Dec. 19, 2019.

LOS ANGELES – The Department of Justice announced today that Nassir Medical Corp. and its owner, Dr. Youram Nassir, have agreed to pay the United States and California $3,356,565 to settle False Claims Act allegations that they defrauded public health care programs by billing for oncology drugs and services that were not actually provided to patients.

Nassir Medical Corp., which does business as Cancer Care Institute, is a hematology and oncology practice based in in the Mid-Wilshire area of the City of Los Angeles. This medical office specializes in treating cancer patients and such treatment often requires physicians to prescribe, dispense, infuse, and administer a variety of oncology drugs. Medicare and Medi-Cal reimburse physicians both for the cost of drugs themselves and for the cost of infusing and administering those drugs to patients.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.