A Florida-based ophthalmology practice, identified as Pinellas Eye Care, operating under the name Gulfcoast Eye Care, with facilities in Pinellas Park, Palm Harbor, and St. Petersburg, has consented to pay a sizable sum of $615,000 to clear up allegations of submitting fraudulent claims to Medicare and Medicaid, detailed in a public announcement from the U.S. Attorney’s Office for the Middle District of Florida.
This hefty settlement is to resolve claims that Gulfcoast Eye knowingly took part in false billings for trans-cranial doppler ultrasounds (TCDs), a service purportedly pimped out through a kickback scheme with another party, wherein it stands accused that they diagnosed a multitude of patients with serious cerebral conditions prior to the actual delivery of their ultrasound results which could frequently not be substantiated by medical history or the ultrasound results themselves.
Outlined by the U.S. Attorney’s Office, the settlement pays $602,046 to the United States, and $12,953 to the State of Florida, as Medicaid is co-funded by both state and federal budgets. "Patients trust their healthcare providers to administer reliable and competent care consistent with their medical needs and ethical standards," U.S. Attorney Gregory W. Kehoe explained, adding that the sanctity of the healthcare system must be safeguarded against such exploitations of patient trust.
FBI and HHS-OIG officials underscored the issue as well, with FBI Tampa Division head Matthew Fodor affirming that exposing deceitful threats to the federal healthcare system is integral to their mission to protect US citizens, while Ryan P. Lynch of HHS-OIG iterated the agency's unyielding stance on unraveling improper billing and kickback operations to shield both Medicare and Medicaid alongside their beneficiaries.
The civil settlement also honored the contribution of a whistleblower, who filed the lawsuit under the qui tam, or whistleblower provision, which allows private entities to sue on behalf of the U.S government for false claims; this individual is set to receive $116,850 resulting from the settlement, as rightly noted by the U.S. Attorney’s Office.
