Radiation Oncologist To Pay $2.35 Million To Settle Claims Of Defrauding The Medicare Program

Today U.S. Attorney Loretta E. Lynch announced the court approval of a settlement with Dr. Gilbert Lederman, the former Director of Radiation Oncology at Staten Island University Hospital (SIUH).  Dr. Lederman has agreed to pay $2.35 million to resolve claims that he defrauded the Medicare Program when he sought reimbursement for stereotactic body radiosurgery (BRS), a procedure which Dr. Lederman claimed to have pioneered in the United States.

The United States asserted that Dr. Lederman violated the False Claims Act (FCA) by billing Medicare for BRS provided to a number of patients at SIUH during the period beginning1996 through 2003.  At that time, Medicare limited coverage for stereotactic radiosurgery to the treatment of cancers above-the-neck and excluded BRS as “investigational,” or experimental. The United States further asserted that Dr. Lederman miscoded his claims to falsely indicate that he had treated patients above-the-neck in order to get paid by Medicare.

“Providers who misrepresent their services -- whether for the purpose of obtaining greater reimbursement or in an effort to conceal the fact that a treatment was deemed investigational -- continue to pose a threat to Medicare, our nation’s largest insurer.  In response, we will continue to vigorously pursue those providers who place their own self-interest above their obligation to accurately report the nature of the services they provide to their Medicare patients,” stated United States Attorney Lynch.

In May 2014, U.S. District Judge John Gleeson granted the United States partial summary judgment against Dr. Lederman.  The Court found, as a matter of law, that certain claims that Dr. Lederman submitted to Medicare for BRS were false because the claims were miscoded and concerned treatment below-the-neck.  The Court also found Dr. Lederman liable to the United States as to claims for unjust enrichment and payment on mistake of fact. United States ex rel. Ryan v. Lederman, 2014 WL 1910096 (E.D.N.Y. May 13, 2014).