Radiation Therapy Provider Pays $3.6M in CMP Settlement; OIG: 25 CPT Codes ‘Involved’

A Colorado radiation therapy provider has agreed to pay $3.569 million in a civil monetary penalty settlement with the HHS Office of Inspector General (OIG).

According to the settlement, OIG alleged that HealthONE Radiation Therapy at Red Rocks LLC, which at the time was part of the HealthONE network of hospitals and clinics in the metro Denver area, billed Medicare and Medicaid for services that were false or fraudulent. Between Jan. 1, 2013, and April 16, 2017, HealthONE allegedly submitted claims for some radiation and oncology services that (1) used incorrect CPT codes and dates of service, (2) were not provided, (3) didn’t have documentation to support the necessity of the services, (4) “were unbundled” and (5) “had incomplete documentation.”

The settlement, which was obtained through a Freedom of Information Act request, stemmed from HealthONE’s self-disclosure to the OIG. A spokesperson for the HealthONE system said it “no longer owns and has no role in the operation of Red Rocks Oncology.”

OIG alleged the improper claims “involved” 25 CPT codes, and “encompass” radiation therapy planning and simulation services and evaluation and management services furnished to patients undergoing radiation

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