CITY, KY - The U.S. Attorney’s Office filed a lawsuit today against a Somerset optometrist and his practice group, alleging that Dr. Philip Robinson and Associates in Eye Care P.S.C., defrauded the Medicare and Medicaid programs.
The lawsuit alleges that the defendants sought and received payment from Medicare and Medicaid for unnecessary eye examinations and for services Robinson didn’t provide.
According to the complaint, Robinson frequently visited area nursing homes and often claimed to treat more than 100 nursing home patients in a single day. The complaint alleges that on certain dates, these services would have required more than 20 hours’ worth of direct patient care per day, and that Robinson was not working inside these nursing homes more than 8 hours per day.
The complaint also claims that the defendants sought payment for routine monthly eye examinations that were unreasonable and unnecessary given the patients’ conditions. Many nursing home patients received an eye examination from Robinson every four to five weeks for five years or more. At times, Robinson billed Medicare for certain eye examinations more than any other optometrist in the United States.
The complaint accuses the defendants of violating the False Claims Act. If found liable, the defendants would face financial penalties between $5,500 and $11,000 per false claim, and would have to repay Medicare and Medicaid three times the amount of the U.S. Government’s loss for the fraud.
“Under the guise of caring for nursing home residents, these defendants exploited the Medicare and Medicaid programs,” said Kerry B. Harvey, United States Attorney for the Eastern District of Kentucky. “Individuals paying for eye care with money from their own pocket would not be expected to pay a doctor to simply monitor their vision with a monthly exam, especially if the exams were as brief and superficial as what Robinson provided. Health care programs funded with taxpayer dollars are no different.”
The investigation preceding the complaint was conducted by agents with the Department of Health and Human Services, Office of Inspector General and the Kentucky Attorney General’s Medicaid Fraud and Abuse Control Unit. Assistant U. S. Attorney Paul McCaffrey will represent the U.S. Attorney’s Office in this case.
Training and seminars for Federal, State, and Local Law Enforcement Agencies including information on the Gatlinburg Law Enforcement Conference - May 5-7, 2015.