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Healthcare – Case Against Large Radiation Oncology Practice Group

Outcome: Confidential Settlement

Tycko & Zavareei LLP partner Jonathan Tycko represented a whistleblower in a qui tam case under the False Claims Act alleging various forms of upcoding and other billing fraud by a large radiation oncology practice group.  The case raised many important and recurring issues about using statistical sampling in healthcare fraud cases and the circumstances under which a physician’s medical judgments can cross the line into fraud.  In an important decision issued in 2020, Judge David G. Campbell of the District of Arizona ruled that the sampling protocol developed by the firm and its experts could be used to prove the alleged False Claims Act violations, and that, under the circumstances presented by this case, the physician’s decisions about treatment options and how to bill for those treatments could be “false” within the meaning of the Act.  The case subsequently settled on confidential terms.

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