Eye care provider convicted of Medicare and Medicaid fraud
GAINESVILLE, Ga. - Matilda Lynn Prince has been convicted by a federal jury of twenty-nine counts of health care fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients.
“Prince stole hundreds of thousands of dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak. “Through our partnership with the Georgia Attorney General’s office, we will continue to fight the costly effects of healthcare fraud in this state that divert critical resources away from citizens who truly need these services.”
“When Matilda Lynn Prince launched her audacious million-dollar fraud scheme by billing Medicare and Medicaid for services she and her associates never provided, she threatened the integrity of these important health care programs and fraudulently pocketed taxpayer funds,” said Special Agent in Charge Derrick L. Jackson of the HHS Office of Inspector General. “Along with our law enforcement partners, we will continue to hold such fraudsters accountable for their scams.”
“The Medicaid Program is designed to provide benefits to some of the most vulnerable members of our community and depends on the integrity and honesty of those providers who bill Medicaid. When a provider bills Medicaid for services they did not provide, they victimize and take advantage of the people who need it the most. Our office will continue to work hand-in-hand with our federal and state partners to investigate these kinds of egregious cases,” said Georgia Attorney General Christopher M. Carr.
According to U.S. Attorney Pak, the charges and other information presented in court: Prince owned Pickens Eye Clinic in Jasper, Georgia, and operated Eye Gallery 20/20 in Calhoun, Georgia. From September 2011 to February 2014, Prince submitted false claims to Medicare and Medicaid for optometry and ophthalmology services that were never provided to patients.
Despite being previously excluded from the Medicare and Medicaid programs in September 2011, and informed of her ineligibility to be employed or involved with any entity that receives Medicare or Medicaid funds, Prince operated under a new eye service company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered. As part of the scheme, Prince targeted her advertising towards senior citizens and disabled populations in housing complexes and community centers, offering on-site eye exams and prescription glasses at no charge to patients on Medicare and Medicaid. Prince contracted with two licensed optometrists to provide basic eye exams. The optometrists would sometimes travel with Prince to perform these exams.
Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures involving the surgical insertion of medical devices called “punctal plugs” into patients' tear ducts to treat dry eye conditions. Prince then used the identities of these two optometrists to bill Medicare and Medicaid repeatedly for this procedure. On some occasions, she billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed. Prince fraudulently submitted over $1.2 million in insurance claims to Medicare and Medicaid for services never rendered.
On January 9, 2018, after a jury trial, Matilda Lynn Prince, 41, of Mineral Bluff, Georgia, was convicted of twenty-nine counts of health care fraud. A sentencing date for Prince has not yet been set.
This case was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General and the Georgia Medicaid Fraud Control Unit.
Assistant U.S. Attorneys Bernita B. Malloy and Nekia S. Hackworth prosecuted the case.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.