Justice Department settles Medicare fraud suit in Melbourne, Florida

April 23, 2010  |  Class Actions, Whistleblower/Qui Tam

The United States has settled a whistleblower lawsuit filed against Florida doctor Todd J. Scarbrough, MD and Melbourne Internal Medicine Associates P.A. (MIMA).  The doctor and MIMA have consented to pay an enormous sum to resolve the suit’s claims that they violated the federal False Claims Act by presenting false claims for payment to Medicare and TRICARE, the military’s federal health care program.

MIMA performs health care services at a number of Brevard County, Florida locations.  Dr. Scarbrough, a radiation oncologist, was the medical director of the MIMA Cancer Center in Melbourne, Florida.  The United States claimed that from its inception until 2008, the MIMA facility in Melbourne had defrauded the health care programs in a variety of schemes.  Under Dr. Scarbrough’s direction, MIMA billed for medical services that had not been supervised, that were duplicative or unnecessary, or that had just plain not been performed.  In addition, the facility upcoded services, a scam in which medical providers perform one service, but then submit a claim to Medicare using a billing code for a more costly procedure.  MIMA executives were shown to have knowledge of many of these phony billing practices, but they took no action to call a halt to the fraudulent billing.

The medical providers’ misconduct originally was revealed in a whistleblower lawsuit filed by Fred Fangman, MIMA’s former director of radiation oncology.  The suit was filed under the False Claims Act, whose Qui Tam provisions permit a private individual to bring a fraud claim on behalf of the government and then receive a share of any settlement.  The whistleblower in this case will be handsomely rewarded for coming forward to report the medical providers’ fraudulent schemes against Medicare and TRICARE.

For the full story, go to Health Leaders Media.

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