A Fleming Island eye-care business will pay $2.1 million to settle accusations it submitted improper claims to Medicare or Medicaid for unnecessary ultrasound procedures, according to the U.S. Justice Department.
Clay Eye Holdings LLC was one of five ophthalmology practices around the state who collectively agreed to nearly $6 million in payments tied to a whistleblower’s lawsuit arguing the firms violated the federal False Claims Act, said a Jan. 15 announcement by the U.S. Attorney’s Office for Florida’s Middle District, which includes Jacksonville.
The False Claims Act, a 19th-century law, is often used to pursue businesses suspected of involvement with kickbacks that increase government costs for services like Medicare, the country’s health care for senior citizens.
“Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making,” Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division said in the release.
The federal courts’ Pacer system for tracking legal cases didn’t list any cases involving Clay Eye Holdings, however.
The Justice Department announcement said the eye-care firms’ payments resolved issues “arising from their billing for trans-cranial doppler ultrasounds (TCDs) through a kickback arrangement” with an unnamed third-party testing company.
“… The United States alleged that as a result of this scheme, the settling practices submitted … false claims to Medicare and Medicaid for TCDs … that were medically unnecessary, [and] that were premised on false diagnoses,” the Justice release said.
Trans-cranial doppler ultrasound tests use sound waves to find conditions, like strokes, affecting blood flow in the brain. Some eye-care providers use the test to examine patients with conditions including migraines, blurred or double vision and some types of glaucoma.
But the Justice release suggested concern the test was being used excessively, saying the firms in the settlements “performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test.
“Before the patients received the results of the test, the practices and the third-party testing company identified the patients as having received a serious diagnosis that could qualify the patient for reimbursement of a TCD by Medicare or Medicaid” the release said. “However, nearly all patients who received TCDs never had that diagnosis, and it was not reflected in the patient’s medical history or in the TCD results.”
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