Florida Ophthalmology Practice Agrees to Pay $1.3M to Resolve Allegations of Fraudulent Claims for Cranial Ultrasounds

Brandon Eye Associates P.A. (Brandon Eye), an ophthalmology practice with offices in Brandon, Sun City and Plant City, Florida, has agreed to pay $1.3 million to resolve alleged violations of the False Claims Act and an analogous Florida statute arising from its billing for trans-cranial doppler ultrasounds (TCDs) provided through a kickback arrangement with a third party. Brandon Eye has agreed to cooperate with the Justice Department's investigations of other participants in the alleged scheme.

"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," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department's Civil Division. "Today's settlement demonstrates that the Justice Department will continue to hold accountable those who enter into kickback arrangements that undermine the integrity of federal health care programs."

The settlement announced today resolves allegations that Brandon Eye knowingly submitted, and caused the submission of, false claims for medically unnecessary TCDs performed on Brandon Eye's patients. Brandon Eye and a third-party provider of turnkey mobile TCD services, through an agreement, performed TCDs on Brandon Eye patients who had been diagnosed with common health conditions such as diabetes, hypertension and glaucoma. Before the patient received the TCD result, Brandon Eye and the third-party provider identified the patients as having received a serious diagnosis - most commonly of occlusion and stenosis of their cerebral arteries - that could qualify the patient for reimbursement of a TCD by Medicare or Medicaid. However, nearly all patients who received TCDs never had occlusion and stenosis of cerebral arteries, and that diagnosis was accordingly not reflected in the patient's medical history or in the TCD results. For each TCD ordered for each Medicare Part B patient, Brandon Eye claimed reimbursement for the technical component of the test, paid the third-party TCD provider based on the volume or value of tests ordered, and referred the patient to the TCD provider's preferred radiology group for the TCD's professional component.

The United States alleged that as a result of this scheme, Brandon Eye submitted, or caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary, that were premised on false diagnoses, and that resulted from violations of the Anti-Kickback Statute and the Stark Law. Of the $1.3 million total settlement amount, $1,210,245.70 is to be paid to the United States, and $89,754.30 is to be paid to the State of Florida for its share of Medicaid, which is a jointly funded federal and state program.

"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 for the Middle District of Florida. "We will continue to pursue these actions against providers who exploit federal health care programs for personal gain."

"We are all victims when the Medicare and Medicaid systems taxpayers fund are cheated," said Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office. "This is why the FBI vigorously investigates alleged kickback schemes and false billing practices, because it is our mission to protect the American people."

"Kickback arrangements meant to boost company profits can corrupt the legitimate medical decision-making process and undermine the integrity of federal healthcare programs," said Special Agent in Charge Stephen Mahmood of the Department of Health and Human Services Office of Inspector General (HHS-OIG). "HHS-OIG and our law enforcement partners will continue to pursue allegations of improper billing and kickback schemes to protect both Medicare and Medicaid and those served by those programs."

The settlement was the result of a coordinated effort between the Civil Division's Commercial Litigation Branch, Fraud Section, and the U.S. Attorney's Office for the Middle District of Florida, with assistance from HHS-OIG and the FBI.

Trial Attorney Nelson Wagner of the Civil Division's Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Mamie Wise for the Middle District of Florida handled the matter.

The government's pursuit of this matter illustrates the government's emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 1-800-HHS-TIPS (800-447-8477).

The claims resolved by the settlement are allegations only. There has been no determination of liability.