Clermont Eye Doctors Agree To Pay Over $157,000 To Settle False Claims Act Liability For Improperly Billing Medicare
Orlando, FL – United States Attorney Maria Chapa Lopez announces today that Dr. Craig D. Fishman and Dr. Jeffrey A. Sheridan have agreed to pay the United States a combined total of $157,312.32 to resolve allegations that they violated the False Claims Act by knowingly billing the government for mutually exclusive eyelid repair surgeries. Dr. Fishman and Dr. Sheridan are ophthalmologists who operate Fishman & Sheridan Eye Care Specialists.
The settlement relates to Dr. Fishman and Dr. Sheridan’s billing of two procedures, blepharoplasty and ptosis. Medicare identifies these procedures as mutually exclusive eyelid repair surgeries that usually should not be billed simultaneously. According to the settlement agreement, from April 11, 2011, through March 31, 2017, Dr. Fishman and Dr. Sheridan each regularly billed for simultaneously performing blepharoplasty and ptosis on patients and submitted those claims to the United States for reimbursement.
“Protecting Medicare and other federal health care programs from fraud is a priority of the U.S. Attorney’s Office,” said U.S. Attorney Maria Chapa Lopez. “This settlement highlights our commitment to identifying doctors who do not follow the law.”
“Improperly billing for services to increase revenue burdens our healthcare system,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG). “Our agency will continue to investigate health care providers that seek to illegally boost profits at the expense of federal health care programs.”
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by two whistleblowers—Dr. Michael Pennachio, a former partner of Drs. Fishman and Sheridan, and Sharon Drake, their former office manager. Dr. Pennachio and Ms. Drake sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting private citizens to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. Dr. Pennachio and Ms. Drake will receive $26,000 of the proceeds from the settlement with Dr. Fishman and Dr. Sheridan.
This settlement resulted from an investigation coordinated by Assistant U.S. Attorney Jeremy R. Bloor, with assistance from the U.S. Department of Health and Human Services Office of Inspector General.
The government’s action in this matter illustrates the emphasis on combating health care fraud, and one of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
The case is captioned United States ex rel. Michael Pennachio, M.D. and Sharon Drake v. Craig D. Fishman, M.D., and Jeffrey A. Sheridan, M.D., Case No. 5:17-cv-152-OC-34PRL. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.