Woman Slated to Receive $4 Million Whistleblower Award
This month a Florida woman can rest easier knowing that her whistleblower case against a physician on Staten Island, New York is finally over…. a case that was filed in June of 2004! Her payday? $4,079,664. Unfortunately, her whistleblower award, while well deserved, is bittersweet. She claims that her husband’s life was cut short by unnecessary medical treatments; the same treatments that gave rise to her whistleblower suit.
Elizabeth Ryan claims that she and her husband were lured to Staten Island University Hospital and Dr. Gil Lederman. She says they claimed to have a 95% success rate in cancer treatment. At the time they sough teatment, Elizabeth’s husband Thomas was suffering from terminal pancreatic cancer.
According to her complaint, the Ryan’s left Florida and travelled to New York to seek treatment for Thomas’ cancer. By doing so, Lederman and the hospital subjected her husband to “expensive, unnecessary and grossly negligent treatment…[thereby] shortening [her] husband’s life and preying upon [them] at their most vulnerable time.”
Ryan also claims that not only were the Stereotactic Body Radiosurgery treatments her husband received medically unnecessary and ineffective, they also were not approved by Medicare and eligible for reimbursement. Instead, she claims they committed Medicare fraud by submitting false claims for payment.
After several years of legal wrangling, Staten Island University Hospital settled with the government for $25 million. Elizabeth Ryan received a whistleblower award of $3,753,414.00 for that portion of the case. Dr. Lederman, however, refused to settle.
On Tuesday, Lederman and the government finally resolved the remaining charges in the complaint. The doctor must now pay the government $2,175,00 of which an additional whistleblower award $326,250 will go to Ryan.
The government contended that during the years in question, Dr. Lederman was the director of the hospital’s radiation oncology department. His specialty was treating cancer with both traditional radiation treatments and the sterotactic treatments. The latter involves focusing high power radiation on a small part of the body. It is often painful and has significant side effects.
Under the federal Medicare law, only medical treatments that are reasonable and necessary are eligible for reimbursement. The Centers for Medicare and Medicaid Services or its delegate determines what treatments may be reasonable. In this case, there was a local guideline that said the sterotactic procedure was not approved for cancers below the neck.
Prosecutors say that Lederman submitted claims to Medicare for at least 300 patients with below-the-neck procedures. Lederman didn’t challenge that fact. Instead he argues that he believed the treatments to be medically reasonable. The court ruled, however, that Medicare gets to make the rules, not the doctor. Said the court, “[if] physician determinations” of reasonableness and necessity “controlled claim payment, there would be no need for a claim reimbursement process at all.”
Is this a case of a physician standing up to Medicare and simply looking out for the best interests of patients? Probably not as the court also determined that Lederman’s bills were false. He used billing codes suggesting the treatments were directed at the skull and brain when in fact he was using the procedure “below the neck” and for Mike Ryan’s pancreas.
A published report in the New York Post claims that Lederman became infamous after “pushing” former Beetles drummer George Harrison to sign a guitar as he lay on his death bed, dying of cancer.
Said U.S. Attorney Loretta Lynch, Lederman placed his self interest above his patient’s interest.
Having a case drag on for 10 years is unusual. Once the government gets involved, however, it simply becomes a matter of time. Happily, Ryan will finally receive a nice whistleblower award. Nothing can alleviate the extra suffering that her husband endured at the hands of Lederman, however.
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