Dr. Gilbert S.

Lederman, a pioneer in radiation oncology and the first doctor in the United States to
perform fractionated stereotactic body radiosurgery, has agreed to settle a civil Federal False Claims Act
lawsuit brought by the United States Attorney on behalf of the U.S. Department of Health & Human
Services. The settlement puts an end to what was a legal nightmare for Dr. Lederman lasting the more
than ten years.
Dr. Lederman, currently in private practice, was Director of Radiation Oncology at Staten Island
University Hospital from 1987 until November 2004. As Director, Dr. Lederman was an independent
contractor who billed for his professional services separately from the hospital. During that time, Dr.
Lederman and Staten Island University Hospital performed hundreds of thousands of radiation
treatments on tens of thousands of cancer patients. He learned about an investigation in 2004, but the
government did not file its complaint until August, 2008. It alleged that of the tens of thousands of
claims Dr. Lederman submitted to Medicare in the eight years spanning 1996 through 2003,
approximately 300 of the claims for reimbursement were for services not covered by Medicare.
Dr. Lederman denied any wrongdoing in the treatment and billing for radiation therapy, including what
he referred to as body radiosurgery, a treatment he defined as radiation treatment using a
stereotactic frame and often, but not always fewer treatments of higher doses, than conventional
radiation. He further denied billing Medicare falsely or fraudulently. He contends that his stereotactic
body radiosurgery was specifically covered and considered medically reasonable and necessary under
Medicares written policies for treatment of various tumors and lesions throughout the body, depending
on the circumstances of each individual patient. Dr. Ledermans contention was vindicated when, at the
end of 2003, the Centers for Medicare and Medicaid Services, Medicares fiscal intermediary in New
York, created specific billing codes for Stereotactic Body Radiation Therapy. Previously, until the end
of 2003, most other insurers, including Medicare, covered Stereotactic Body Radiation Therapy using
standard billing codes.
As the director of two separate hospital radiation oncology departments and presently the head of
Radiosurgery New York, Dr. Lederman has always appreciated the importance of combatting fraud and
waste in the practice of medicine. At Radiosurgery New York, a private clinic in Manhattan comprised of
a unique team of physicians, physicists, radiation technologists, dosimetrists and nurses, focusing on
advancing technology, quality assurance and data compilation in the field, Dr. Lederman continues to
recognize its importance, all the while knowing he is ultimately responsible for any billing errors or
overpayments, no matter who makes them. Billing and coding for reimbursement of the constantly
evolving science of radiation treatment is a technologically complex specialty. It requires years of study,
training, and experience. It is usually done by private consulting companies or institutions, as was the
case for most of the billing at issue here. Since he began performing body radiosurgery, Dr. Lederman
has always strived to employ the best and most experienced billing experts, and continues to do so at
Radiosurgery New York.

The governments case consisted of two separate theories. First, that Dr. Ledermans fractionated
stereotactic body radiosurgery was categorically prohibited by Medicare policies a claim Dr. Lederman
vehemently denied. He and his staff at Staten Island University Hospital performed literally hundreds of
thousands of the procedures for tens of thousands of patients including many thousands of claims that
were submitted to and paid by Medicare. Medicare never denied payment for the treatments, even
after an audit was performed in 2001 and 2002. Staten Island University Hospital also performed an
intensive audit of the billing and coding of radiosurgery during the same time period and found the
treatment to be covered. The department was accredited by the American College of Radiology, and
regularly inspected and licensed by the New York State Department of Health and New York Citys
Department of Health and Mental Hygiene. At the height of his practice there were more than eighty
employees in the Department of Radiation Oncology at Staten Island University Hospital, several of
whom were deposed by the government. Not one testified that Dr. Lederman ever performed
treatment that was not medically necessary nor approved by Medicare, and Medicare never denied
payment for his treatments, belying the claim that the treatment was categorically prohibited by
Medicare.
Second, and at the heart of the governments case, was a computerized list of 277 patients for whom
322 claims were submitted. The government claimed incorrect billing or diagnoses codes were
submitted to Medicare for these claims. From the initiation of this lawsuit the defendant demanded the
government produce all medical and billing records for those patients. Since the defendant was no
longer associated with Staten Island University Hospital, he did not have access to those records. No
present or former employee of Staten Island University Hospital, Dr. Ledermans practice or his billing
companies testified that the bills to Medicare were inaccurately or improperly coded. Without medical
records showing what specific treatment was given to the individual patients, it is impossible to show
whether treatment was or was not medically necessary or properly billable to Medicare. The
government contended that even though no records existed for most of the patients, it was Dr.
Ledermans obligation to prove what treatment was performed. From the records that were obtained, it
was determined that there were some errors in coding and billing. However, analyses done by billing
and coding experts who reviewed them determined that in most of the cases where incorrect billing
codes were submitted, Dr. Lederman would have been paid more for his services if the correct codes
were submitted.
In a False Claims Act case, proof of intentional fraud is not required: the submission of a claim that is
incorrectly coded, even accidentally, may be false under the Act. The damages for minor errors are
harsh: the government is entitled to recover three times the overpayment plus penalties of up to
$11,000 per claim, plus attorneys fees. The defendant is not entitled to an offset even if the miscoded
bills were actually under billed as they were in most cases here. If liability were found on even one
claim, the defendant would stand to have his Medicare privileges revoked for years. Although the case
was near trial, appeals and further proceedings would likely last several more years. Dr. Lederman was
willing to continue his fight for vindication and justice, however, the threat of losing his Medicare
privileges and thus his ability to continue to help his patients, which was and is his primary goal,
convinced him to settle the case and move on with his practice.

Questions regarding the settlement are referred to Dr. Ledermans attorney, Jack Tracy, at Tracy &
Stilwell and Partners, 1688 Victory Boulevard, Staten Island, New York 10314. He can be reached at 718720-7000 and his email address is jtracy@tracyandstilwell.com.