A U.S. cancer care provider has reached an agreement with the federal government to pay $34.7 million in settlement money for Medicaid fraud.

21st Century Oncology Inc. and its subsidiary, South Florida Radiation Oncology LLC, faced allegations that they committed Medicaid fraud by purposely performing medically unnecessary procedures and billing Medicaid for them.

The federal government claimed in the Medicaid fraud lawsuit that 21st Century Oncology billed Medicaid for a procedure known as the Gamma function, knowing that it served no medical purpose and is therefore considered medically unnecessary, and should not be billed to Medicaid.

Essentially, the Gamma function measures patients the exit dose of radiation from patients who have received radiation treatment.

The federal government made a number of claims against 21st Century Oncology’s billing of Medicaid for this Gamma function. Firstly, that the procedure was completed by physicians who were not sufficiently qualified to perform the Gamma function and deal with the results.

The government also claimed that physicians did not review the results until seven days after the procedure, and there were technical failures in the equipment that rendered results unavailable.

Because of these technical failures and improper execution, the procedures should have been considered medically unnecessary.

Despite this, the Medicaid fraud lawsuit claims, the cancer care provider still billed Medicaid.

According to Principal Deputy Assistant Attorney General Benjamin C. Mizer, the Medicaid fraud settlement “demonstrates our unwavering commitment to protect the Medicare trust fund against unscrupulous providers.”

Mizer further stated that “Providers who waste taxpayer dollars by billing for unnecessary services, including services that are not used or improperly performed, will face serious consequences.”

The Medicaid fraud lawsuit was prompted by a whistleblower within the company, 21st Century Oncology Inc., which is the largest integrated cancer care provider in the United States.

The whistleblower, Joseph T., used to work at South Florida Radiation Oncology as a physicist. He is set to receive over $7 million for his part as the whistleblower for this Medicaid fraud lawsuit under the False Claims Act.

This Medicaid fraud lawsuit is the second of its kind against 21st Century Oncology in the last several months alone. The company recently settled other False Claims Act allegations for $19.75 million after being accused of billing Medicaid for medically unnecessary urine tests.

Whistleblowers Can Expose Medicaid Fraud

Employees or former employees of companies that may be practicing fraudulent or illegal activities against the government may blow the whistle, calling attention to the fraud on behalf of the government.

Though it can be scary for an employee to blow the whistle, as they may be worried they will get in trouble or lose their job because of it, a whistleblower is usually given a substantial reward from any settlement money the lawsuit provides. For many who blow the whistle, this can be between 15 and 30 percent of the settlement money.

If you believe that your employer or former employer is participating in fraudulent or illegal behavior against the federal government, you may be able to file a whistleblower lawsuit.