Source: United States Department of Justice Criminal Division
Florida ophthalmology practices Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc. have agreed to pay a total of nearly $6 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. All five practices have agreed to cooperate with the Justice Department’s ongoing investigations of other participants in the alleged scheme.
“Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Combatting such schemes will continue to be a priority for the Justice Department.”
“These settlements are a continuing testament to the United States’ commitment to fight healthcare fraud and ensure that federal healthcare dollars are spent consistently with the law,” said U.S. Attorney Gregory W. Kehoe for the Middle District of Florida.
“Submitting false claims destroys the public’s trust in our federally funded healthcare programs,” said Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office. “Working together with our law enforcement partners, the FBI will continue to prioritize safeguarding the integrity of the nation’s healthcare system and hold accountable those who try to profit from deception.”
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” said Acting Special Agent in Charge Ricardo Carcas of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG, working with our law enforcement partners, will continue to investigate improper billing and kickback schemes to protect both Medicare and Medicaid as well as those served by these programs.”
The settlements announced today resolve allegations that the settling practices knowingly submitted, and caused the submission of, false claims to Medicare and Medicaid for medically unnecessary TCDs. 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 identified the patients as having received a serious diagnosis that could qualify the patient for reimbursement of a TCD by Medicare or Medicaid. However, 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. The settling practices paid the third-party testing company based on the volume or value of tests ordered and referred the patients to the testing company’s preferred radiology group for the TCDs’ professional component.
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 between Jan. 1, 2018 and June 1, 2022 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, Clay Eye Holdings LLC will pay $2,140,000, Retina Macula Specialist of Miami LLC will pay $1,750,000, Florida Eye Institute P.A. will pay $1,250,000, Miami Eye LLC will pay $525,000, and Kendall Eye Institute Inc. will pay $310,000. Of the total settlement amount, $333,500 will be paid to the State of Florida 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 $1,135,250 in connection with the settlements.
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. and Pinellas Eye Care, P.A. (doing business as Gulfcoast Eye Care).
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).
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.