Fort Myers, FL – United States Attorney Maria Chapa Lopez announces today that Eye Centers of Florida has agreed to pay the United States $525,000 to resolve allegations that it violated the False Claims Act by knowingly falsifying medical records in order to bill for cataract surgeries on patients that would not have otherwise qualified for the surgery.
Founded in 1971, Eye Centers of Florida is an ophthalmology practice owned by David C. Brown, M.D. Eye Centers of Florida currently has 11 office locations throughout southwest Florida, with the main clinic located in Fort Myers.
The term “visual acuity” refers to the sharpness or clarity of vision. An individual’s visual acuity is generally measured using vision-testing charts to determine the person’s ability to distinguish letters or other images of various sizes at a fixed distance. “Normal” vision is 20/20. Generally, Medicare will consider a cataract surgery medically necessary and reasonable if, among other things, a patient has a visual acuity worse than 20/40 with impairment of ability to carry out needed or desired activities.
According to the settlement agreement it was the United States contention that, from January 1, 2012, through March 1, 2014, employees of Eye Centers of Florida knowingly falsified the medical records of certain Medicare Advantica patients that were referred to Dr. Brown for a cataract surgery evaluation in order to make it appear that the patients had a worse visual acuity score than they had actually received. The United States contended that as a result of these practices, Eye Centers of Florida was able to bill for cataract surgeries for patients that would not have otherwise qualified under Medicare guidelines.
“Altering records in order to justify billing for unnecessary invasive medical procedures is a violation of the trust we place in our health care providers and potentially places lives at risk,” said U.S. Attorney Chapa Lopez. “Our Civil Division works tirelessly in the pursuit of providers who fraudulently bill Medicare, or any other federal health care program, for services that are medically unnecessary.”
“Altering results of examination scores to conduct invasive ocular procedures, as alleged, threatens the health of those patients, the public’s faith in the medical profession, and the financial integrity of Medicare and Medicaid,” said Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General. “We will continue to safeguard these taxpayer-funded programs and the beneficiaries who rely on them.”
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by two former employees of Eye Centers of Florida, Patti Nilsson and Joann Smith. Nilsson and Smith sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen 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. Nilsson and Smith will receive $115,500 of the proceeds from the settlement with Eye Centers of Florida.
This settlement resulted from an investigation coordinated by Assistant U.S. Attorneys Kyle S. Cohen and David Sullivan, with assistance from the U.S. Department of Health and Human Services Office of Inspector General and the FBI.
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 U.S. ex. rel. Nilsson and Smith v. Eye Centers of Florida, Docket Number 2:13-cv-842-FtM-38CM. 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.