Cash forked over in settlement about false medical claims

By Linda Wilkins and Maegan Rocio

Assistant City Editor

and Staff Writer

The Department of Justice announced Tuesday the Baylor Health Care System must pay $907,355 to settle allegations of false claims for radiation oncology services.

The Baylor Health Care system is an umbrella term that encompasses the Baylor University Medical Center and the Health Texas Provider Network, two organizations mentioned in the settlement.

None of the organizations are affiliated with Baylor University.

Baylor Health Care established autonomy from the university in 1997 when it decided to continue its commitment to support the university’s nursing and medical education programs.

The organizations that allegedly received the false claims are Medicare, the Civilian Health and Medical Program of the Uniformed Services and the Federal Employees Health Benefit Program.

The settlement arose from allegations that Baylor University Medical Center submitted improper claims to Medicare from 2006 to May 2010.

The claims involved several bills that were double-bills, bills for higher or less expensive services, bills without supporting documentation in the medical record and bills for radiation treatment delivery without corroboration of physician supervision.

According to the Department of Justice, the radiation oncology services included intensity modulated radiation therapy, which is a complex radiation treatment for specific types of cancer that require precision in order to spare patients’ organs and tissues.

Craig Civale, the spokesman for the Baylor University Medical Center, wrote in an email to the Lariat that the settlement was reached to avoid a long-term court battle.

“The issue involved a disagreement with the Department of Justice on the adequacy of some of our billing records at the Radiosurgery Center Department at Baylor University Medical Center. To avoid protracted and expensive litigation, Baylor has paid the DOJ $907,355 to settle this issue. We are pleased that the matter is concluded,” he wrote.

Lori Fogleman, director of media communications at Baylor, said she was not aware of the announcement by the Department of Justice.

“We are entirely separate legal entities though our institutions enjoy many associations,” Fogleman wrote in an email to the Lariat.

The Associated Press contributed to this article.