PINELLAS COUNTY, Fla. – Pinellas Eye Care, P.A., operating as Gulfcoast Eye Care, an ophthalmology practice with offices in Pinellas Park, Palm Harbor, and St. Petersburg, Florida, has agreed to pay $615,000 to resolve allegations of False Claims Act violations.
The settlement stems from alleged fraudulent billing practices related to transcranial Doppler ultrasounds (TCDs) provided through a kickback arrangement with a third-party vendor.
The agreement requires Gulfcoast Eye Care to pay $602,046 to the United States and an additional $12,953 to the State of Florida, representing Florida’s share of the Medicaid program. Furthermore, Gulfcoast Eye Care has pledged cooperation with the Justice Department’s ongoing investigations into other participants in the alleged scheme.
The settlement addresses claims that Gulfcoast Eye Care knowingly submitted, and caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary. According to the allegations, Gulfcoast Eye Care and a third-party TCD provider performed TCDs on thousands of patients, billing Medicare and Medicaid hundreds of dollars per test.
Investigators found that prior to patients receiving their test results, Gulfcoast Eye Care and the third-party provider would identify patients as having received a serious diagnosis – most commonly occlusion and stenosis of their cerebral arteries – which could qualify the patient for reimbursement of a TCD by Medicare or Medicaid. However, a significant majority of patients who underwent TCDs never actually had occlusion and stenosis of cerebral arteries, and this diagnosis was not supported by their medical history or the TCD results.
The United States further alleged that Gulfcoast Eye Care compensated the third-party TCD provider based on the volume or value of tests ordered and referred patients to the TCD provider’s preferred radiology group for the professional component of the TCDs. This arrangement is alleged to have violated the Anti-Kickback Statute and the Stark Law, in addition to leading to claims for medically unnecessary services based on false diagnoses.
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“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. “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 schemes will always be an investigative priority for the FBI,” said Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office. “Our mission is to protect the American people which includes safeguarding them from deceitful actions threatening our nation’s federal healthcare system.”
The civil settlement arose from a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act. This provision allows private parties to file suit on behalf of the United States for false claims and receive a portion of the government’s recovery.
In connection with this settlement, the whistleblower will receive $116,850.
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