Five practices agree to $6M settlement with DOJ as investigation into Medicare fraud scheme continues
Five eye care clinics in Florida have agreed to pay nearly $6 million to resolve accusations of fraud related to their use of transcranial Doppler ultrasounds as part of a kickback scheme.
According to the U.S. Department of Justice (DOJ), the ophthalmology practices would refer patients for the tests unnecessarily as part of an arrangement with a third-party diagnostics company to bill Medicare and Medicaid for hundreds of dollars per incident.
The DOJ said that while the providers and the testing company would claim patients had a serious diagnosis that would warrant a cranial ultrasound, that was often not the case. Scans would come back negative, and a look into the medical history of the patients showed they never had these serious conditions in the first place.
The practices would refer patients to the unnamed testing company's “preferred radiology group,” which would conduct the ultrasounds. The DOJ said the eye clinics themselves would pay the testing company kickbacks based on the value and volume of tests ordered, which it then billed to Medicare and Medicaid.
Prosecutors maintain that the cranial ultrasounds were not backed by medical evidence in patient records. The incidents are said to have occurred between 2018 and 2022.
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” Acting Special Agent in Charge Ricardo Carcas of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) said in a statement. “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.”
An ongoing investigation
By agreeing to the civil settlement, the allegations are now resolved. The DOJ said all five of the ophthalmology groups are cooperating with investigators, who are still conducting an investigation into potential crimes associated with the conspiracy.
The practices, and their agreed-upon penalties, are as follows:
- Clay Eye Holdings will pay $2,140,000.
- Retina Macula Specialists of Miami will pay $1,750,000.
- Florida Eye Institute P.A. will pay $1,250,000.
- Miami Eye LLC will pay $525,000.
- Kendall Eye Institute will pay $310,000.
Authorities said that $335,500 of the settlement fund will be given to the state of Florida to reimburse losses to Medicaid. As the initial complaint against the practices was brought by a whistleblower under protection of the False Claims Act, that person will receive $1,135,250, the DOJ confirmed.
No other charges have been announced. Any potential remaining defendants have yet to be named.
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