Optometry Practice Agrees to Pay $16,343 to Settle Civil Health Care Fraud Case

Portland, Maine: Acting United States Attorney Richard W. Murphy today announced that Brunswick Eye Care Associates, P.C. (“BECA”) has entered into a civil settlement agreement with the United States and the State of Maine in which it will pay $16,343 to resolve allegations that it submitted false claims to Medicare, TRICARE, the Department of Veterans Affairs (“VA”), and MaineCare (Maine’s Medicaid program) from May 7, 2014 through April 29, 2016. MaineCare is primarily funded by the United States, which pays about two-thirds of all claims submitted to MaineCare.

According to a civil complaint filed today, BECA billed and received reimbursement from Medicare, TRICARE, the VA, and MaineCare for services provided by BECA, and then improperly used a portion of the funds received from these programs to pay the salary and benefits of a BECA employee who previously had been excluded from Federal health care programs and the MaineCare program. Prior to joining BECA, the employee had been excluded based upon her conviction for stealing drugs while employed as a pharmacy technician. Before employing this woman, BECA failed to ask her whether she had ever been excluded from participation in any Federal health care program or MaineCare. BECA also did not check the publicly available exclusion databases maintained by the Department of Health and Human Services’ Office of Inspector General and MaineCare’s Program Integrity Unit, despite federal regulations prohibiting the employment of excluded providers.

Federal health care programs may not pay, directly or indirectly, for items or services furnished, ordered, or prescribed by excluded individuals or entities. This prohibition extends to administrative and clerical personnel, and is not limited to health care providers. By failing to abide by the requirements of the MaineCare and Federal health care programs regarding the employment of excluded individuals, BECA acted with reckless disregard of the falsity of the claims it submitted to MaineCare and Federal health care programs.

The case was investigated by the U.S. Department of Health & Human Services, Office of Inspector General, and the Attorney General’s Office of the State of Maine. The civil action is docketed United States and the State of Maine v. Brunswick Eye Care Associates, P.C., 2:17-cv-257-DBH (D. Me.).