Ophthalmologist Agrees To Pay $1.4 Million And To 20 Year Voluntary Exclusion From Federal Programs To Settle Claims That He Performed Medically Unnecessary Laser Procedures
Baltimore, Maryland – John Arthur Kiely, M.D., of Lutherville, Maryland, has agreed to pay the United States $1.4 million to settle claims under the Federal False Claims Act that he submitted and caused the submission of false claims by Bon Secours Hospital to Medicare and Medicaid between October 29, 2002 and April 14, 2009. Kiely has also agreed to a 20 year voluntary exclusion from Federal health care programs.
The settlement was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Nicholas DiGiulio, Office of Inspector General of the Department of Health and Human Services, Philadelphia Region which includes Maryland.
“Medical advice must be motivated by the patient’s best interest and not by the doctor’s personal financial interest,” said U.S. Attorney Rod J. Rosenstein. “The government contended in this case that Dr. John Kiely performed glaucoma surgery because it was profitable for him, even when it was not necessary and not appropriate.”
“We are pleased Dr. Kiely agreed to resolve the allegations of falsely billing government health programs for unnecessary and excessive medical procedures,” said Nick DiGiulio, Special Agent in Charge for the Inspector General’s Office of the United States Department of Health and Human Services. “We rely on physicians to perform only needed services and to bill appropriately. In addition to payment, Dr. Kiely has agreed to be excluded from participation in all Federal health care programs for at least 20 years.”
The settlement arises out of an investigation that resulted in the United States filing a civil complaint on July 12, 2013 in U.S. District Court in Maryland, captioned United States v. John Arthur Kiely, M.D., Civil No. MJG-11-668, in which the United States charges that Kiely, a general ophthalmologist, submitted claims to Medicare and Medicaid for laser eye procedures that fell outside the medical standard of care. The government contends that because the procedures did not meet the medical standard of care, they were not reasonable and necessary as required for reimbursement by Medicare and Medicaid. The claims covered by the settlement agreement include Argon Laser Trabeculoplasties (ALTs) between October 29, 2002 and September 11, 2007; Lysis of Adhesions procedures between October 29, 2002 and April 14, 2009; and Laser Peripheral Iridotomies (LPIs) between November 12, 2002 and September 26, 2006. An ALT is a laser procedure performed to treat open angle glaucoma, while LPI is a laser procedure performed to treat narrow angle glaucoma. Kiely performed between 3 and 14 ALTs per eye on the 120 patients identified in the civil complaint, and also performed repeated Laser Peripheral Iridotomies and Lysis of Adhesions on many of these patients.
Kiely performed these laser procedures primarily at Bon Secours Hospital in Baltimore, Maryland. The settlement covers false or fraudulent claims submitted by him to Medicare and Medicaid directly, as well as hospital fees arising out of these laser procedures that he caused Bon Secours Hospital to submit to Federal health care programs.
Dr. Kiely denies the allegations.
Enacted during the Civil War, the False Claims Act is the government’s primary civil tool to combat fraud and abuse in federal programs and procurement. The Act allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim and permits the payment of a portion of any settlement or judgment under the Act to individuals who bring fraud to the attention of authorities.
United States Attorney Rod J. Rosenstein commended Assistant U.S. Attorneys Tarra DeShields and Roann Nichols, who handled the case.