Shore Health agrees to settlement for unsupervised therapy, services

The civil settlement was announced by United States Attorney for the District of Maryland Erek L. Barron and by Special Agent in Charge Maureen Dixon of the U.S. Department of Health and Human Services, Office of the Inspector General.

“It is imperative that Medicare and other federal health care programs are protected from fraud because those programs are funded through taxpayer dollars,” said United States Attorney Erek L. Barron. “The United States Attorney’s Office will hold accountable those providers who defraud federal health care programs.”

“Providers who submit false claims to Medicare are undermining the integrity of federal health care programs,” said Special Agent in Charge Maureen Dixon, at the Department of Health and Human Services, Office of the Inspector General (HHS-OIG). “HHS-OIG is proud to work alongside our law enforcement partners to protect valuable taxpayer dollars from fraud.”

Shore Health is a part of the University of Maryland Medical System and primarily serves the needs of Maryland residents in Caroline, Dorchester, Queen Anne’s, Talbot and Kent counties. According to the settlement agreement, from Jan. 16, 2014 through July 5, 2018, Shore Health billed Medicare for radiation therapy and diagnostic services. During this time period, Medicare covered radiation therapy and diagnostic services furnished in an outpatient setting when rendered under the direct supervision of a physician.

“Direct supervision” means that the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. At all relevant times, Shore Health had only one physician, John Mastandrea, M.D., available to supervise radiation therapy and diagnostic services.

This settlement resolves allegations that on many occasions, Dr. Mastandrea was performing uninterruptible radiation oncology services at a separate location while unsupervised radiation therapy and diagnostic services were being performed at Shore Health.

A spokesperson from the University of Maryland Shore Regional Health issued the following statement regarding the allegations.

"(The) University of Maryland Shore Regional Health takes the responsibility of caring for our communities very seriously. The organization acted in good faith in interpreting the Centers for Medicare & Medicaid Services physician supervision guidelines in place at the time, and found that no patient harm resulted from this practice. CMS has since relaxed the supervision regulations at issue in this matter."

This matter arose from a lawsuit filed by J. Phillip Sawyer, a former employee of Shore Health, under the whistleblower provision of the False Claims Act. The False Claims Act permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery. As part of the settlement, Sawyer will receive $51,952.

The claims resolved by this settlement are allegations. The settlement is not an admission of liability by Shore Health nor a concession by the United States that its claims are not well founded.

United States Attorney Erek L. Barron commended the HHS-OIG for their work in this investigation. Barron thanked Assistant U.S. Attorney Vince Vaccarella and former Assistant U.S. Attorney Allen Loucks who handled this case.

This story has been updated.