Brandon Eye Associates to Pay $1.3M for False Billing and Kickback Scheme Violations

TL/DR –

Florida-based ophthalmology practice Brandon Eye Associates P.A. has agreed to pay $1.3 million to resolve allegations of violations of the False Claims Act and a corresponding Florida statute relating to its billing for trans-cranial doppler ultrasounds provided through a kickback scheme. The Justice Department accused Brandon Eye of knowingly submitting false claims for medically unnecessary procedures performed on patients who were falsely diagnosed with severe health conditions to qualify them for Medicare or Medicaid reimbursement. Of the total settlement, $1,210,245.70 will be paid to the United States, while $89,754.30 will go to the State of Florida for its share of Medicaid.

Florida Ophthalmology Practice Settles False Claims Act Allegations for $1.3 Million

Brandon Eye Associates P.A., a Florida based ophthalmology practice, has agreed to a $1.3 million settlement over alleged violations of the False Claims Act and a similar Florida statute. The violations stem from billing for trans-cranial doppler ultrasounds (TCDs) provided through a kickback arrangement with a third-party. Brandon Eye will cooperate with the Justice Department’s investigation into other parties involved in the alleged scheme.

The settlement reinforces the Justice Department’s commitment to hold accountable those who undermine the integrity of federal health care programs through kickback arrangements. Such arrangements can influence medical decision-making, lead to unnecessary services, and increase health care costs at the taxpayers’ expense.

The case revolves around Brandon Eye knowingly submitting false claims for medically unnecessary TCDs performed on its patients, many diagnosed with common health conditions such as diabetes, hypertension and glaucoma. In collusion with a third-party TCD services provider, Brandon Eye performed TCDs on patients. They falsely identified these patients as having serious diagnoses that would qualify them for TCD reimbursement by Medicare or Medicaid. However, almost all patients who received TCDs didn’t have the serious diagnoses claimed, and these diagnoses were not recorded in the patient’s medical history or in the TCD results.

As a result of this scheme, false claims were allegedly submitted to Medicare and Medicaid for TCDs that were medically unnecessary, based on false diagnoses, and in violation of the Anti-Kickback Statute and the Stark Law. Of the $1.3 million total settlement amount, $1,210,245.70 will be paid to the United States, and $89,754.30 will be paid to the State of Florida for its share of Medicaid, which is a jointly funded federal and state program.

This settlement underscores the commitment of the U.S. Attorney’s Office to investigate and hold responsible medical providers who exploit federal health care programs for unnecessary medical tests at taxpayers’ expense. The FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG) will continue to pursue allegations of improper billing and kickback schemes.

The settlement is the result of a collaborative effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Middle District of Florida, supported by HHS-OIG and the FBI. Tips about possible fraud, waste, abuse and mismanagement can be reported to HHS at 1-800-HHS-TIPS (800-447-8477).

The settlement addresses only the allegations. There has been no determination of liability.

—
Read More Health & Wellness News ; US News