Optometry Practice Settles False Claims Act Allegations Regarding Medically Unnecessary Exams

optometry practice false claims act

A Pulaski County optometry office has agreed to settle claims of fraudulent billing practices for $800,000.
Image source: Wikimedia Commons

When it comes to unlawful billing practices settled under the False Claims Act, nursing homes and long-term care facilities are frequently implicated in fraudulent misconduct with regard to the various services they offer to residents. In today’s case, the federal government recently reached a settlement with Kentucky-based Associates in Eye Care following an investigation that revealed the provision of medically unnecessary services to various long-term care patients across the state.

According to the press release published by the Department of Justice, the scheme was uncovered following an investigation by the Department of Health and Human Services and a whistleblower/relator was not actually involved. However, in many False Claims Act lawsuits, successful whistleblowers are able to recover up to 30 percent of the ultimate settlement or jury verdict.

Details of the case against Associates in Eye Care

The case against Associates in Eye Care was handled by the U.S. Attorney’s Office for the Eastern District of Kentucky. According to allegations brought forth by the Department of Justice, AEC and one of its primarily optometrists, Dr. Philip Robinson, were in the business of regularly visiting nursing homes for purposes of providing eye examinations and routine vision care for patients. Patients enrolled in Medicaid for long-term care or Medicare for short-term stays are afforded vision coverage, provided the examinations and treatment procedures are medically necessary to ensure proper sight for the patient. More specifically, Medicaid enrollees may be covered for treatment of glaucoma, cataracts (and removal surgery), eye disease, optic nerve damage, and medically necessary eyewear.

Allegedly, for a period ranging from 2007 through 2012, AEC and Dr. Robinson performed monthly eye examinations on each and every patient in the facilities visited, regardless of whether the patient’s care plan required such frequent vision checks. According to the government, the vast majority of these examinations were a medically unnecessary waste of taxpayer dollars and Medicaid resources. Medicaid and HHS authorities became suspicious of Dr. Robinson and AEC after reviewing the sheer volume of patients visited each day, making it virtually impossible for each visit to be medically valuable.

Government’s response

The U.S. Attorney’s Office for the Eastern District of Kentucky said in a statement, “Federally funded healthcare programs provide an essential safety net for many of our most vulnerable citizens….Those who abuse the system for personal gain jeopardize the programs on which so many rely. We are committed to using every available tool to protect these vital programs from fraud and abuse.”

Interestingly, the $800,000 settlement resolves claims against only AEC, and does not resolve the government’s allegations against Dr. Robinson individually. Dr. Robinson has elected to endure the rigors of a trial, which is set for April 2015.

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By | 2018-03-26T04:16:59+00:00 February 25th, 2015|Healthcare Fraud|