Scappa was a urologist practicing as part of Scappa Urology, which was a division of 21st Century Oncology, LLC. 21st Century is a nationwide provider of integrated cancer care services that is headquartered in Fort Myers. As part of its business, 21st Century employs and affiliates with physicians in specialty fields such as radiation oncology, medical oncology, and urology.
The allegations that doctors affiliated with 21st Century were ordering unnecessary FISH tests were originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery.
The whistleblower, a former medical assistant who worked for David Spellberg, M.D. at Naples Urology Associates, which was also a division of 21st Century Oncology, will receive $37,500 as her share of this recovery. This amount is in addition to a $3.2 million share she will receive as the result of the $19.75 million settlement previously reached with 21st Century Oncology.
The settlement announced today resolves allegations that Scappa caused to be submitted claims to Medicare and Tricare for fluorescence in situ hybridization, or “FISH,” tests that were not medically necessary. FISH tests are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer. Medicare does not consider a FISH test reasonable or necessary unless it’s used to monitor for tumor reoccurrence in a patient previously diagnosed with bladder cancer or unless, after performing a full urologic workup, the physician has reason to suspect that a patient with hematuria (i.e., blood in the urine) may have bladder cancer.
In January 2009, Scappa began referring all of the FISH testing ordered by him to a laboratory owned and operated by 21st Century. He was paid bonuses by the company based, in part, on the number of FISH tests he referred to 21st Century laboratory. The settlement is based on Scappa’s ability to pay.
The settlement announced today resolves allegations that Scappa caused to be submitted claims to Medicare and Tricare for fluorescence in situ hybridization, or “FISH,” tests that were not medically necessary. FISH tests are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer. Medicare does not consider a FISH test reasonable or necessary unless it’s used to monitor for tumor reoccurrence in a patient previously diagnosed with bladder cancer or unless, after performing a full urologic workup, the physician has reason to suspect that a patient with hematuria (i.e., blood in the urine) may have bladder cancer.
In January 2009, Scappa began referring all of the FISH testing ordered by him to a laboratory owned and operated by 21st Century. He was paid bonuses by the company based, in part, on the number of FISH tests he referred to 21st Century laboratory. The settlement is based on Scappa’s ability to pay.
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