FISHing for Fraud

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Sometimes it’s better not to be number one. Being number one is usually associated with being a winner, but in today’s ”Fraud of the Day,” a Florida urologist who was deemed the number one referring physician in the country for a particular type of bladder cancer test, got knocked down a notch after a former employee blew the whistle on him, three other associates and their medically unnecessary orders.

The ”number one” urologist in Florida ordered $13,000 unnecessary genetic ”fluorescence in situ hybridization” or FISH tests for his patients. (This test helps to detect genetic abnormalities associated with cancer.) He received $2 million in bonuses from the FISH tests referrals to his company’s laboratories. (Sounds like he was FISHing for fraud.)

This top physician was not the only doctor implicated in an investigation carried out by the Department of Health and Human Services. In all, four physicians employed by the nation’s largest radiation oncology provider were named in a $19.75 million settlement with the government.

The top doc paid nearly $4 million to end the agency’s investigation against him. In addition, he must hire an independent review organization to evaluate his medical records over the next three years to make sure they comply with Medicare and Medicaid regulations. While he has resigned from the oncology practice, he plans to continue to practice medicine.

One of the other doctors involved in the settlement paid $250,000 to the government and retired. Another doctor who paid $1.05 million to settle similar claims was responsible for firing the former medical assistant who blew the whistle by raising concerns about the doctors’ testing practices.

It turns out that the oncology provider was also involved in another $34.7 million settlement with the government regarding unnecessary GAMMA function tests, which measure the amount of radiation emitting from patients after specific medical treatments. The whistleblower was the real winner in this case. She will receive $571,500 for alerting federal investigators plus another $3.4 million regarding other settlements. (I guess the government found her testimony to be quite illuminating.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”21st Century Oncology doc pays almost $4M to settle fraud case,” published by Vermont Business Magazine on December 28, 2016.

A 21st Century Oncology physician implicated in a federal crackdown on unnecessary bladder cancer tests has agreed to pay nearly $4 million to end the investigation against him.

Dr. Meir Daller, who operates Gulf Stream Urology practices in Fort Myers, Cape Coral and Bonita Springs, was among the four physicians named in a $19.75 million settlement the government reached with 21st Century Oncology in December 2015.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.