Hillsborough ophthalmology practice to pay $1.3M in false claims case

An ophthalmology practice in Hillsborough County has agreed to pay $1.3 million to settle allegations it made false claims for medically unnecessary ultrasounds.

Brandon Eye Associates — which has locations in Sun City, Brandon and Plant City — was accused of violating the False Claims Act and an analogous Florida statute arising from its billing for transcranial doppler ultrasounds (TCDs) provided through a kickback arrangement with a third party, according to a statement from the U.S. Department of Justice.

To resolve the allegations, Brandon Eye Associates will pay $1,210,245.70 to the United States and $89,754.30 to the state of Florida for its share of Medicaid, a jointly funded federal and state program. While the company has agreed to pay the settlement, there has been no determination of liability, according to the U.S. Department of Justice.

Through an agreement, Brandon Eye Associates and a third-party provider of turnkey mobile TCD services performed the ultrasounds on Brandon Eye patients with common health conditions like diabetes, hypertension and glaucoma, authorities contended. Before the patients got their results, Brandon Eye Associates and the third-party provider identified them as having a serious diagnosis — most commonly occlusion and stenosis of their cerebral arteries — that could qualify the patients for Medicare or Medicaid reimbursement of a TCD, the statement says. However, nearly all patients who received the TCDs never had occlusion and stenosis of cerebral arteries, and the diagnosis was in neither their medical histories nor their TCD results, according to the statement.

For each TCD ordered for each Medicare Part B patient, Brandon Eye Associates 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, officials alleged.

As a result of the alleged scheme, federal authorities say Brandon Eye Associates submitted false claims to Medicare and Medicaid for TCDs that were medically unnecessary; were premised on false diagnoses; and violated the Anti-Kickback Statute and Stark Law, which prohibits providers from referring a patient to a health care entity if providers have a financial relationship with the entity.

“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,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, says in the statement. “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.”

“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,” U.S. Attorney Roger Handberg for the Middle District of Florida says in the statement. “We will continue to pursue these actions against providers who exploit federal health care programs for personal gain.”

The U.S. Department of Justice’s fraud section and civil division’s commercial litigation branch as well as the U.S. Attorney’s Office for the Middle District of Florida handled the matter, with assistance from the FBI and the U.S. Department of Health and Human Services’ Office of Inspector General.

Federal officials say Brandon Eye Associates has agreed to cooperate with the justice department’s investigations of other participants in the alleged scheme.