Source: United States Department of Justice Criminal Division
New York ophthalmology practices Mark D. Fromer, P.C. doing business as Fromer Eye Centers and Floral Park Ophthalmology P.C. have agreed to pay a total of $2.3 million to resolve alleged violations of the False Claims Act arising from their billing for trans-cranial doppler ultrasounds (TCDs) through a kickback arrangement with a third-party testing company. The Estate of Mark Fromer, the former owner of Fromer Eye Centers, also joined in the settlement with the practice. Both practices have agreed to cooperate with the Justice Department’s ongoing investigations of other participants in the alleged scheme.
“The integrity of healthcare decision-making depends on sound medical advice that is free from undue influence of illegal kickbacks and other improper arrangements,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The Department will continue to hold accountable healthcare providers who engage in such schemes.”
“Medical service providers who place profit above patients not only compromise the integrity of our health care system, but patients’ care,” stated U.S. Attorney Gregory W. Kehoe for the Middle District of Florida. “Our office will continue working with our partners to combat fraud against our federal health care programs.”
“Kickback arrangements work to corrupt impartial medical decision-making and drive up health care costs for everyone,” said Special Agent in Charge Isaac M. Bledsoe of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG will continue to work closely with our law enforcement partners to investigate and hold accountable those who attempt to defraud federal health care programs.”
The settlements announced today resolve allegations that the settling practices knowingly submitted, and caused the submission of, false claims to Medicare (and, with respect to Fromer Eye, Medicaid) for medically unnecessary TCDs. The United States alleges that the settling practices performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test. Before the patients received the results of the test, the practices and the third-party testing company allegedly identified the patients as having received a serious diagnosis that could qualify the patient for reimbursement of a TCD. However, the United States alleged that nearly all patients who received TCDs never had that diagnosis, and it was not reflected in the patient’s medical history or in the TCD results. In addition, Floral Park Ophthalmology allegedly received remuneration paid by the third-party testing company to induce the practice to refer its Medicare and Medicaid patients to the testing provider for TCDs.
The United States alleged that as a result of this scheme, the settling practices submitted, or caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary, that were premised on false diagnoses, and that resulted from violations of the Anti-Kickback Statute and the Stark Law.
As a result of the settlements, Fromer Eye Centers and the Estate of Mark Fromer will pay $1,800,000 and Floral Park Ophthalmology will pay $500,000. Of the total settlement amounts, $384,000 will be paid to the State of New York for its share of Medicaid, which is a jointly funded federal and state program.
The civil settlements resolved claims in a lawsuit filed under the qui tam or whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the Government’s recovery. The qui tam was filed by a whistleblower who will receive approximately $132,000 in connection with the settlement with Fromer Eye Centers.
The settlements were the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Middle District of Florida, with assistance from HHS-OIG and the FBI. The United States previously resolved similar allegations against Brandon Eye Associates P.A., Pinellas Eye Care, P.A. (doing business as Gulfcoast Eye Care), Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc.
The government’s pursuit of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to HHS at 1-800-HHS-TIPS (800-447-8477).
This year the Administration launched the Task Force to Eliminate Fraud and the National Fraud Enforcement Division to enhance the Administration’s war on fraud, waste, and abuse in federal programs. When unscrupulous actors exploit these programs for their own financial gain, they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules. The Civil Division’s FCA enforcement plays a critical role in combatting such fraudulent schemes, recovering billions of dollars for the American taxpayers, and holding wrongdoers accountable. FCA matters will continue to be on the forefront of the battle against fraud, and the Civil Division’s FCA work will support and advance the mission of the Task Force to Eliminate Fraud and the National Fraud Enforcement Division. Trial Attorney Nelson Wagner in the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Mamie Wise for the Middle District of Florida handled the matter.
The claims resolved by the settlements are allegations only and there has been no determination of liability.