Baylor agrees to settle whistle-blower case

The 928-bed Baylor University Medical Center in Dallas and its affiliated HealthTexas Provider Network have agreed to pay $907,000 to settle whistle-blower allegations that the hospital and physicians fraudulently billed Medicare and Tricare for radiation oncology services between 2006 and 2010.

The settlement agreement (PDF) between the Justice Department, the providers and corporate parent Baylor Health Care System accused physicians and hospital officials of double-billing for radiation-treatment plans and charging for costly radiation oncology services when less-expensive services should have been billed, among other practices.

A news release said the allegations involved modulated radiation therapy, a sophisticated treatment used for specific types of cancer when “extreme precision is required to spare patients' surrounding organs or healthy tissue.”

Baylor officials denied the allegations and any wrongful conduct, and said the settlement was struck to avoid the cost and uncertainty of protracted litigation.

“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.”

Whistle-blowers Dr. Brian Berger and Janice Delp, who first brought the allegations in the False Claims Act lawsuit, will receive a portion of the settlement, though the amount was not disclosed in the agreement. Investigators with the Justice Department, FBI and the inspector general's offices of the HHS and Defense Department were involved in the investigation.