New York ophthalmology practices agree to pay $2.3 million over Medicare, Medicaid ultrasound claims

Traders Union
All News
Financial News
NY ophthalmology Medicare settlement

Highlights

Fromer Eye Centers and the Estate of Mark Fromer will pay $1.8 million, and Floral Park Ophthalmology $500,000, to settle alleged False Claims Act violations related to unnecessary TCD ultrasounds billed to Medicare and Medicaid.
Authorities allege Floral Park Ophthalmology accepted remuneration from a third-party testing company to induce Medicare and Medicaid referrals, raising potential Anti-Kickback Statute and Stark Law violations.
$384,000 of the settlement will go to New York for Medicaid recoveries and the whistleblower is set to receive $132,000 from the Fromer Eye Centers settlement.

Settlement terms and alleged billing scheme

As reported by U.S. Department of Justice, the settlements resolve allegations under the False Claims Act linked to claims submitted to Medicare and, in Fromer Eye Centers' case, Medicaid, for medically unnecessary trans-cranial doppler ultrasounds, or TCDs.

The government alleges the practices performed TCDs on thousands of patients and billed federal programs hundreds of dollars per test through an arrangement involving a third-party testing company. It says patients were identified in advance as having a diagnosis that could support reimbursement, even though nearly all patients who received the tests allegedly never had that diagnosis and it was not reflected in their medical histories or test results.

Federal authorities also allege Floral Park Ophthalmology received remuneration from the third-party testing company to induce referrals of Medicare and Medicaid patients, creating potential violations of the Anti-Kickback Statute and the Stark Law. Fromer Eye Centers and the Estate of Mark Fromer are to pay $1.8 million, while Floral Park Ophthalmology is to pay $500,000.

Enforcement impact and recovery allocation

Of the total settlement amount, $384,000 is to go to New York for its share of Medicaid recoveries. The matter stems from a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act, and the whistleblower is to receive about $132,000 from the Fromer Eye Centers settlement.

The Justice Department says both practices have agreed to cooperate with ongoing investigations into other participants in the alleged scheme. The case involves the Civil Division's Commercial Litigation Branch, Fraud Section, the U.S. Attorney's Office for the Middle District of Florida, HHS-OIG and the FBI, and follows earlier resolutions involving other practices in similar allegations.

Our previous report on the Justice Department’s multi-state fraud enforcement push across the U.S. Southeast described 17 cases tied to more than $350 million in intended losses. It also highlighted the rollout of new federal-state task forces and cooperation agreements designed to speed fraud detection, tighten coordination, and strengthen prosecutions across programs that include Medicaid.

This material may contain third-party opinions, none of the data and information on this webpage constitutes investment advice according to our Disclaimer. While we adhere to strict Editorial Integrity, this post may contain references to products from our partners.