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.
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.
Through an agreement, Brandon Eye and a third-party provider of turnkey mobile TCD services performed TCDs on Brandon Eye patients 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 them for reimbursement of a TCD by Medicare or Medicaid.
However, nearly all patients who received TCDs never had occlusion and stenosis of cerebral arteries. That diagnosis was not reflected in the patient’s medical history or 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 will be paid to the United States, and $89,754.30 will be paid to the State of Florida for its share of Medicaid, a jointly funded federal and state program.
“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.
“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).
