Naples Urology Doc Spellberg $1.5M Settlement on Medicare Billing Fraud Allegations

Florida based urologist David Spellberg recently agreed to repay the federal government $1.5 million dollars for allegedly unnecessary medical tests he ordered while working at Naples Urology Associates.

Naples Urology Doc Spellberg $1.5M Settlement on Medicare Billing Fraud Allegations

Whistleblower Mariela Barnes Racks up 2nd Cash Award

This is the second settlement to benefit whistleblower Mariela Barnes whose False Claims Acts allegations prompted Naples Urology Associates parent company, 21st Century Oncology, to pay the federal government $19.75 million last December.

Dr. David Spellberg allegedly violated the False Claims Act when he ordered a staggering number of unnecessary laboratory tests which were later covered by federal healthcare programs including Medicare and Tricare.

The tests cost Medicare millions of dollars. In fact, they may not only have been unnecessary, but also overpriced, as data provided by Medicare revealed that the federal program had been paying other local providers ten times less for a similar test.

21st Century Oncology Alleged MD Kickbacks for More Tests

When he became an employee of 21st Century in January 2010, Spellberg started referring FISH (fluorescence in situ hybridization – detects gene abnormalities) testing to a laboratory owned by 21st Century itself. Instead of the less expensive traditional FISH tests, the laboratory performed a computer assisted version of it, often billing ten times as much. 21st Century offered monetary incentives for physicians who ordered a high number of FISH tests, a fact that was disclosed in an email signed by 21st Century Oncology executive, Michael Tompkins.

The communication came soon after 21st Century opened a new clinical tests laboratory in Fort Myers. A few months after the email promised the healthcare provider´s urologists a substantial cut of revenue from the tests, the number of FISH tests ordered by doctors associated with 21st Century Oncology escalated from 202 in May 2009 to 924 in October of the same year.

The alleged actions of both 21st Century and Dr. Spellberg appear even more questionable when considering the efficacy of FISH testing in the diagnosis of bladder cancer. In fact, recent studies have pointed to a significant number of false positives. Thus, the healthcare provider may have ordered millions of dollars worth of overpriced tests of questionable efficiency for patients who probably didn´t need cancer testing in the first place.

In a statement, U.S. Attorney A. Lee Bentley, III condemned fraudulent practices affecting public healthcare programs, “We intend to hold those accountable who intentionally use fraudulent practices to make a profit at others’ expense…False claims such as these impact the solvency of our public healthcare programs and erode the confidence of those being serviced by that care.”

Mariela Barnes’ Whistleblower Lawsuit Nets Her $3.2M & $200K

Whistleblower Mariela Barnes, who used to be Spellberg´s direct medical assistant. received $3.2 million after the settlement in the original lawsuit and is set to receive another $199,500 following the new agreement with Dr. Spellberg.

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