Feds: Florida Ophthalmology Practice Paid Kickbacks, Defrauded $1.3 Million
Brandon Eye Ophthalmology Practice, which has three locations in Florida, will pay $1.3 million in a settlement with federal prosecutors.
The violations were a result of Brandon Eye billing government programs for transcranial ultrasounds, which the feds say were not medically necessary in many cases. Prosecutors also claimed that Brandon Eye had a kickback arrangement with a third party, another violation of federal and state laws.
Medically Unnecessary Tests and Kickbacks
Brandon Eye knowingly submitted medically unnecessary transcranial ultrasounds performed on their patients, which led to the submission of false claims, according to prosecutors. A third party, unnamed in the press release, provided the ultrasounds on Brandon Eye patients who had been diagnosed with diabetes, hypertension and glaucoma.
But while Brandon Eye claimed these patients had more serious diagnoses–most commonly of occlusion and stenosis of their cerebral arteries– there was nothing in their medical history or record that supported that.
That meant the transcranial ultrasounds were not medically necessary and should not have been medically reimbursable by Medicare or Medicaid. Brandon Eye field for reimbursement anyway, part of which they paid to the third-party mobile ultrasound company.
Legal Violations
The scheme violated the Anti-Kickback Statute and the Stark Law. Brandon Eye will pay $1.3 million, according to the settlement. This amount includes $1,210,245.70 that Brandon Eye will reimburse the federal Medicare program, and $89,754.30, which they will pay back to Florida’s Medicaid.
Brandon Eye’s settlement does not include admitting to the charges or acknowledging liability, even though they agreed to pay the fine.
Brandon Eye hasn’t publicly commented on this topic so far.
Comments by Officials
High-level officials at the Justice Department hailed the settlement, noting that kickbacks negatively affect health care for everyone.
“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 in a public release by the Department of Justice.
“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, whose office handled the case.
The Department of Health and Human Services, another federal agency, also highlighted the negative effect kickbacks have on health care.
“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.
Report Tips on Medical Fraud Here
The Justice Department wants to hear from people who have tips and complaints regarding potential medical fraud. You can make a report by calling the Department of Health Services at 1-800-HHS-TIPS (800-447-8477) or reporting online here.
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