Gulfcoast Eye Care, an ophthalmology practice with offices in Pinellas Park, Palm Harbor, and St. Petersburg, has agreed to pay $615,000 to settle allegations of submitting false claims to Medicare and Medicaid through a kickback arrangement involving medically unnecessary trans-cranial doppler ultrasounds (TCDs).
According to the U.S. Department of Justice, Gulfcoast Eye knowingly billed federal healthcare programs for TCDs based on false diagnoses, primarily occlusion and stenosis of cerebral arteries, which were not supported by patients’ medical histories or the TCD results. Gulfcoast Eye allegedly paid a third-party TCD provider based on the number of tests ordered and referred patients to the provider’s preferred radiology group.
“Patients trust their healthcare providers to administer reliable and competent care consistent with their medical needs and ethical standards,” said U.S. Attorney Gregory W. Kehoe for the Middle District of Florida. “When this relationship is exploited for personal gain or greed, the integrity of our healthcare system is compromised. We will continue working with our law enforcement partners to protect patients from potential harm and maintain the integrity of our federal programs.”
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” said Acting Special Agent in Charge Ryan P. Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG, working with our law enforcement partners, will continue to investigate improper billing and kickback schemes to protect both Medicare and Medicaid as well as those served by these programs.”
The False Claims Act and Florida False Claims Act settlement includes payments of $602,046 to the United States and $12,953 to the State of Florida for Medicaid overpayments.
The practice has agreed to cooperate in ongoing federal investigations into other participants in the alleged scheme.
A whistleblower who filed suit under the qui tam provisions of the False Claims Act will receive $116,850 as part of the government’s recovery.
The investigation was conducted by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Middle District of Florida, the FBI Tampa Field Office, and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).
This is the second settlement involving an ophthalmology group in Florida linked to the same third-party TCD provider.
Comments are closed, but trackbacks and pingbacks are open.