In a hefty settlement that's hitting the headlines, Florida-based Pinellas Eye Care, P.A., otherwise known as Gulfcoast Eye Care, has agreed to cough up $615,000 to clear the air over allegations that they were playing fast and loose with Medicare and Medicaid, according to a release by the U.S. Department of Justice. The ophthalmology practice with locations in Pinellas Park, Palm Harbor, and St. Petersburg found itself in hot water over claims that they billed for trans-cranial doppler ultrasounds (TCDs) that should never have been on the tab in the first place, thanks to an alleged kickback setup with a third-party actor.
Here's where it gets particularly dicey; Gulfcoast Eye was accused of submitting false claims for TCDs that patients didn't really need, billing Medicare and Medicaid a pretty penny per test on the back of bogus diagnoses, such as cerebral artery occlusion and stenosis, before patients even got their hands on the test results, which typically showed none of the said conditions. What's more, they were paying the third-party provider based on how many tests got ordered and funneling patients their way, raising all kinds of red flags about their ethical compass. The settlement, dishing out $602,046 to Uncle Sam and another $12,953 to the Sunshine State for Medicaid, puts this particular case to bed but leaves the door wide open for possible further probes into anyone else who might have a role in the scam, as per the U.S. Attorney's Office.
Officials don't mince words when it comes to the sin of kickbacks, with "Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office" underscoring their commitment to uproot schemes that threaten the nation's federal healthcare system. Likewise, "Acting Special Agent in Charge Ryan P. Lynch of the U.S. Department of Health and Human Services Office of Inspector General" emphasized the intent to maintain the sanctity of both Medicare and Medicaid as well as those served by these programs. As this sorted affair sees what's likely just its first act draw to a close, whistleblowers out there can take heart; the individual who blew the whistle on Gulfcoast Eye is walking away with a cool $116,850 for their part, as per the U.S. Attorney's Office.
It's evident that the Department of Justice isn't letting its guard down when it comes to healthcare fraud, using all the tools at its disposal like the False Claims Act to lay down the law, and the Gulfcoast Eye case is just the latest example of this steadfast vigilance. Those in the know with hints of any potential healthcare shadiness are urged to step forward and can report any suspect dealings to HHS by dialing 1-800-HHS-TIPS (800-447-8477), where what they say could just be the linchpin in the next big healthcare fraud case.
