Brandon Eye Associates P.A., an ophthalmology practice in Florida, has agreed to pay $1.3 million to resolve allegations of submitting fraudulent claims for trans-cranial doppler ultrasounds (TCDs). The settlement addresses accusations of violating the False Claims Act and a similar Florida statute through a kickback arrangement with a third party.
"The payment of kickbacks can bias medical decision making, result in unnecessary services, and drive up health care costs at the expense of the American taxpayers," stated Brian M. Boynton, Principal Deputy Assistant Attorney General. He emphasized that the Justice Department remains committed to holding accountable those involved in such arrangements.
The allegations against Brandon Eye involve knowingly submitting false claims for medically unnecessary TCDs performed on patients diagnosed with common conditions like diabetes and hypertension. The practice, along with a third-party provider, identified patients as having serious diagnoses eligible for Medicare or Medicaid reimbursement despite these conditions not being present.
According to the United States' allegations, this scheme led to false claims being submitted to Medicare and Medicaid. Of the total settlement amount, $1,210,245.70 will be paid to the United States and $89,754.30 to Florida for its share of Medicaid.
"This settlement demonstrates the continued commitment of the U.S. Attorney’s Office to investigate and hold responsible medical providers seeking reimbursement from federal health care programs for unnecessary medical tests at taxpayers’ expense," said U.S. Attorney Roger Handberg.
FBI Special Agent in Charge Matthew Fodor noted that "we are all victims when the Medicare and Medicaid systems taxpayers fund are cheated." He reiterated that investigating such schemes is crucial to protecting Americans.
Stephen Mahmood from HHS-OIG highlighted that "kickback arrangements meant to boost company profits can corrupt legitimate medical decision-making processes." He affirmed their ongoing efforts against improper billing practices.
The resolution resulted from collaboration between various government entities including the Civil Division’s Commercial Litigation Branch and U.S. Attorney’s Office for the Middle District of Florida.
Trial Attorney Nelson Wagner and Assistant U.S. Attorney Mamie Wise managed this case emphasizing the government's focus on combating healthcare fraud through tools like the False Claims Act.
The resolved claims remain allegations without any determination of liability.