Tampa, FL – Five ophthalmology practices in Florida have consented to pay a total of $5,975,000 to settle claims that they submitted fraudulent Medicare and Medicaid claims for cranial ultrasounds, as announced by federal officials.
The clinics involved—Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc.—are accused of engaging in a kickback scheme with a third-party testing firm to bill for unnecessary trans-cranial doppler ultrasounds (TCDs). All five practices have agreed to assist with ongoing investigations by the Justice Department into other individuals involved in the alleged scheme.
The Justice Department reports that these practices conducted TCDs on thousands of patients, charging hundreds of dollars for each test to Medicare and Medicaid. Prior to delivering results to patients, the practices and the third-party testing company labeled patients as having serious diagnoses that would warrant reimbursement, despite the fact that nearly all patients did not actually have such conditions. The clinics are said to have compensated the testing company based on the number or value of tests ordered and directed patients to the company’s preferred radiology group for the professional aspect of the TCDs.
The government claims that this scheme, which took place between January 1, 2018, and June 1, 2022, led to false claims for medically unnecessary TCDs, violating both the Anti-Kickback Statute and the Stark Law.
Under the settlements, the payment amounts are:
- Clay Eye Holdings LLC – $2,140,000
- Retina Macula Specialist of Miami LLC – $1,750,000
- Florida Eye Institute P.A. – $1,250,000
- Miami Eye LLC – $525,000
- Kendall Eye Institute Inc. – $310,000
A total of $333,500 will be designated for the State of Florida to support its share of Medicaid, a program funded collaboratively by both federal and state governments.
These settlements arise from a qui tam lawsuit initiated by a whistleblower under the False Claims Act, which permits private individuals to file lawsuits on behalf of the government and obtain a share of the funds recovered. The whistleblower is set to receive $1,135,250 from these settlements.
“Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division.
The United States previously resolved similar allegations against Brandon Eye Associates P.A. and Pinellas Eye Care, P.A. (doing business as Gulfcoast Eye Care).
