Florida ophthalmology practices Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc. have agreed to pay a total of nearly $6 million to resolve alleged violations of the False Claims Act arising from their billing for trans-cranial doppler ultrasounds (TCDs) through a kickback arrangement with a third-party testing company. All five practices have agreed to cooperate with the Justice Department’s ongoing investigations of other participants in the alleged scheme. The settlements resolve allegations that the settling practices knowingly submitted, and caused the submission of, false claims to Medicare and Medicaid for medically unnecessary TCDs.
The settling practices 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. 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. The settling practices paid the third-party testing company based on the volume or value of tests ordered and referred the patients to the testing company’s preferred radiology group for the TCDs’ professional component.