Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California, will pay $1.085 million to resolve allegations that they submitted and caused the submission of false claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (commonly known as the “Stark Law”) and the Anti-Kickback Statute, the Department of Justice announced. Drs. Apaydin and Worsham own and operate Salinas Valley Urology Associates (SVUA) in Salinas, California. They also owned Advance Radiation Oncology Center (AROC), located in Salinas, California, which dissolved in 2016. IGRT is used to treat patients who are diagnosed with cancer, including prostate cancer patients.
“Health care laws prevent health care providers, and physicians in particular, from referring Medicare services in exchange for financial incentives,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department's Civil Division. “The Department of Justice is committed to enforcing those laws and preventing physicians from improperly injecting profit motives into their decisions about patient care.”
The Anti-Kickback Statute and the Stark Law are intended to ensure that a physician's medical judgment is not compromised by improper financial incentives. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by federal health care programs, including Medicare. The Stark Law forbids health care providers from billing Medicare for certain services referred by physicians who have a financial relationship with the entity performing the service, unless an exception applies.
“The United States Attorney's Office is committed to protecting the residents of the district from unlawful financial schemes that compromise patient care,” said Acting U.S. Attorney Alex G. Tse. “Patients who use our federal health care programs deserve care that is free from fraud. The few doctors who choose to engage in this type of conduct not only undermine the system, but impugn the many honest and dedicated medical professionals who serve our community.”
The United States alleged that Drs. Apaydin and Worsham knowingly caused eight urologists in Monterey and Salinas, California (the “Lessee Urologists”) to violate the Anti-Kickback Statute and the Stark Law. Drs. Apaydin and Worsham allegedly solicited the Lessee Urologists to enter into lease agreements with AROC under which the Lessee Urologists could bill for, and thereby profit from, their referrals of IGRT performed at AROC. The United States also alleged that Drs. Apaydin and Worsham violated the Stark Law by improperly billing Medicare for their own IGRT referrals to AROC, despite the fact that AROC and SVUA were separate entities and their financial arrangements did not comply with any exceptions to the Stark Law.
The Lessee Urologists previously entered into settlement agreements pertaining to their IGRT claims, under which they collectively agreed to pay the United States $900,000.
The United States' investigation was a coordinated effort by the Civil Division of the Department of Justice, the U.S. Attorney's Office for the Northern District of California, and the Department of Health and Human Services Office of Inspector General.
The claims settled by this agreement are allegations only; there has been no determination of liability.
Topic(s): False Claims ActHealth Care Fraud
Press Release Number: 18-74Updated January 23, 2018
Northern District of California DOJ / 18-74 / January 23, 2018