Telemedicine Nurse Practitioner Pleads Guilty to $7.8 Million Durable Medical Equipment Fraud Scheme
Psychiatrist Convicted of Billing Medicare and Private Insurance Companies for Services Never Rendered
BOSTON – Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates, Inc., and the Foundation of the Massachusetts Eye and Ear Infirmary, Inc. (collectively “Massachusetts Eye and Ear”) have agreed to pay $2.678 million to resolve allegations that they violated the False Claims Act.
Massachusetts Eye and Ear provides inpatient and outpatient services to patients with a range of ailments involving the eye, ear, nose and throat. Over an eight-year period, Massachusetts Eye and Ear improperly billed federal health care programs for certain office visits, defrauding the United States of more than a million dollars.
“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” said Acting United States Attorney Nathaniel R. Mendell. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”
“Our federal healthcare system relies on the basic premise that providers abide by the rules and bill properly, and the American taxpayers who fund the Medicare and Medicaid programs deserve nothing less,” said Phillip Coyne, Special Agent in Charge, Office of the Inspector General of the U.S. Department of Health and Human Services. “Today’s announcement demonstrates our continued and unwavering commitment to rooting out false claims that threaten the integrity of our healthcare system.”
“Mass Eye and Ear received more than a million dollars from fraudulently billing federal healthcare programs over the course of eight years, undermining the integrity of our healthcare system, and increasing the financial burden on hard-working taxpayers,” said Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division. “We would like to thank the patient who had the courage to come forward with allegations of illegal conduct, and we’d like to encourage others to do the same because standing up for what’s right and safeguarding taxpayer dollars is critical, given that every year, the submission of false claims to the government costs taxpayers billions.”
The United States contends that between Jan. 1, 2012 and Feb. 1, 2020, Massachusetts Eye and Ear regularly submitted claims to Medicare and MassHealth—Massachusetts’s Medicaid program—for office visits at which physicians performed certain medical procedures, specifically, nasal endoscopies and laryngoscopies. Medicare and MassHealth do not permit billing for such office visits in addition to billing for the procedures, except under special circumstances that were not present here. As a result of the illegal conduct, Massachusetts Eye and Ear obtained reimbursements to which it was not entitled.
The False Claims Act settlement resolves allegations originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties, known as relators, to bring suit on behalf of the government and to share in any recovery. In connection with today’s announced settlement, the relator will receive 15 percent of the recovery.
Acting U.S. Attorney Mendell, HHS-OIG SAC Coyne and FBI Boston SAC Bonavolonta made the announcement today. Assistant U.S. Attorneys Steven Sharobem and Charles Weinograd of Mendell’s Affirmative Civil Enforcement Unit handled the matter.