The Department of Justice (DOJ) has announced that two Florida-based ophthalmology practices—Fromer Eye Centers and Floral Park Ophthalmology P.C.—agreed to pay a total of $2.3 million to resolve allegations that they violated the False Claims Act (FCA) by billing Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds (TCDs) through an arrangement with a third-party testing company.
The United States alleged that the practices knowingly submitted or caused false claims for TCDs performed on thousands of patients, with Medicare and Medicaid billed hundreds of dollars per test. Before patients received their test results, the practices and the testing company allegedly identified them as having a serious diagnosis that could support reimbursement for a TCD.
According to the government, nearly all patients who received the tests did not have that diagnosis, and the diagnosis appeared neither in the patients’ medical histories nor in the TCD results. The government therefore alleged that the tests were medically unnecessary and that the resulting claims were premised on false diagnoses.
The government separately alleged that Floral Park Ophthalmology received remuneration from the third-party testing company to induce referrals of Medicare and Medicaid patients for TCDs. The DOJ contended that the arrangement resulted in claims tainted by violations of the Anti-Kickback Statute (AKS) and the Stark Law.
The settlements resolve claims brought in an FCA qui tam action. The whistleblower will receive approximately $132,000 in connection with the Fromer Eye Centers settlement; no separate relator-share amount was announced for Floral Park Ophthalmology.
Both practices agreed to cooperate with the DOJ’s continuing investigations of other participants in the alleged scheme. The DOJ also noted earlier resolutions involving similar allegations against several Florida ophthalmology practices, signaling continued scrutiny of provider-testing-company arrangements involving TCDs.
GWB represents healthcare providers in connection with government investigations and False Claims Act litigation. If you need assistance with such a matter, contact us today.
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