01/28/2020 | Press release | Distributed by Public on 01/28/2020 13:21
Orlando, Florida - United States Attorney Maria Chapa Lopez announced today that the United States has filed a federal civil lawsuit against Surgical Care Affiliates, Inc., the Orlando Center for Outpatient Surgery, L.P., and Dr. Patrick T. Hunter, alleging that they falsely billed Medicare and TRICARE, over a seven-year period, for unnecessary kidney stone procedures, and engaged in an illegal kickback arrangement in which Dr. Hunter referred patients to the Orlando Center. The complaint alleges that Dr. Hunter violated the federal False Claims Act by performing lithotripsy procedures, which use shockwaves to destroy kidney stones, when there were no kidney stones present. The complaint further alleges that SCA and the Orlando Center knew of Dr. Hunter's unnecessary lithotripsy procedures, and continued to bill the facility component of Dr. Hunter's procedures to the federal government.
According to the government's allegations, SCA and the Orlando Center engaged in multiple peer reviews indicating that Dr. Hunter told patients they had kidney stones when he had not identified any. Despite this, the government alleges, SCA and the Orlando Center continued to pay Dr. Hunter per procedure for each patient he referred to the Orlando Center. The payments were not commensurate with fair market value, resulting in payments of over $5 million for the use of two machines that were valued at less than $40,000. It is further alleged that SCA requested a fair market value analysis, which required an annual cap of less than $800,000 be paid to Dr. Hunter; and that SCA and the Orlando Center then paid Dr. Hunter over $1.3 million, well in excess of what had been required by the fair market value analysis.
The United States' complaint is filed in a whistleblower lawsuit originally filed in 2016, by Scott Thompson, SCA's Director of Compliance when the allegations took place. The lawsuit was filed under the qui tam provisions of the False Claims Act, which permits private parties to sue on behalf of the United States for false claims for government funds and to receive a share of any recovery. The Act also allows the government to intervene or take over the lawsuit, as it has done in this case, and to recover treble damages plus civil penalties ranging from $5,500 to $11,000 for each false claim submitted by the defendants.
The United States filed a Suggestion of Death with its complaint, stating that Dr. Hunter died in 2019. A motion filed by the government requests the substitution of the personal representative of Dr. Hunter's estate as a defendant in the case.
The claims asserted against SCA, the Orlando Center, and Dr. Hunter's estate are allegations only, and there has been no determination of liability.
This case is being investigated by the Department of Justice, the U.S. Department of Health and Human Services - Office of Inspector General, and the Defense Criminal Investigative Service. It is being prosecuted by Assistant United States Attorney Jeremy Bloor.
Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).