Florida Ophthalmology Practices Agree to Pay Nearly $6M in Whistleblower Case Involving Transcranial Doppler Ultrasounds
By the Constantine Cannon Whistleblower Team
Five Florida ophthalmology practices, Clay Eye Holdings LLC, Retina Macula Specialists of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc., agreed to pay roughly $6 million to settle allegations that they submitted fraudulent claims to Medicare and Medicaid in violation of the False Claims Act. [1]
According to the government, the five practices knowingly billed Medicare and Medicaid for medically unnecessary transcranial Doppler ultrasounds, or TCDs, performing the tests on thousands of patients and charging hundreds of dollars per procedure.
The government further alleged that the practices engaged in a kickback arrangement with a third-party testing company. Each practice has agreed to cooperate with the DOJ’s ongoing investigations into other participants in the alleged scheme.
The Alleged Scheme
The scheme allegedly ran from January 1, 2018, to June 1, 2022. During that period, the practices worked with a third-party testing company that identified patients as having a serious diagnosis that might qualify for Medicare or Medicaid reimbursement for TCD testing before the patients received any test results. Almost all patients who received TCDs did not have a qualifying diagnosis.
The practices allegedly paid the third-party testing company based on the number or value of tests ordered. As part of the arrangement, the practices referred the patients to a radiology group selected by the testing company for the professional component of the TCDs.
Violations of the Anti-Kickback Statute and Stark Law
The claims submitted were for medically unnecessary tests, based on false diagnoses, and resulted from violations of the Anti-Kickback Statute and the Stark Law.
Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division commented: “Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making. Combatting such schemes will continue to be a priority for the Justice Department.”
The Practices’ Settlements
Clay Eye Holdings LLC will pay $2,140,000, Retina Macula Specialists 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. From the total settlement amount, the State of Florida will receive $333,500 for its share of Medicaid, a jointly funded federal and state program.
Case Initiated by a Whistleblower
This lawsuit was filed under the qui tam (or whistleblower provision) of the False Claims Act, which allows private parties to file lawsuits on behalf of the government and receive up to 30% of the government’s recovery. The whistleblower in this case will receive $1,135,250 as a reward.
Healthcare Fraud Whistleblowers
As demonstrated with this recent case, whistleblowers are instrumental in reporting healthcare fraud. The whistleblower rewards of the federal and state False Claims Acts reflect the significant role whistleblowers can play in saving money for U.S. taxpayers and ensuring the integrity of government healthcare programs.
Our Firm Represents Healthcare Fraud Whistleblowers
“This settlement reflects the government’s continued focus on schemes that drive unnecessary medical testing. Whistleblowers often provide the inside information needed to identify these practices and protect patients and government healthcare programs from fraud,” said Constantine Cannon attorney Dan Noel.
Constantine Cannon has extensive experience representing whistleblowers under the False Claims Act. If you would like to learn more about what it means to be a whistleblower or if you believe you have a case, please contact us and we will connect you with an experienced member of our whistleblower team for a free and confidential consultation.
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Sources:
[1] See https://www.justice.gov/opa/pr/five-ophthalmology-practices-agree-pay-nearly-6m-resolve-allegations-fraudulent-claims .
Tagged in: Anti-Kickback and Stark, False Claims Act,