South Florida Marketer Pleads Guilty to Role in Scheme Involving Purchase and Sale of Millions of Medicare Beneficiary Identification Numbers
Clear Vue Eye Center, Inc. (Clear Vue) and its owner, Dr. Monique Barbour have agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region, made the announcement.
“The Medicare program, a vital component of our health care system, is threatened when providers bill fraudulently or carelessly for their own financial interests” said U.S. Attorney Wifredo Ferrer. “The United States Attorney’s Office remains vigilant in investigating and resolving claims of Medicare fraud brought under the False Claims Act.”
“It is hard to imagine how a single practitioner believed billing for more hours than were possible to perform in a day would not alert law enforcement to a potentially fraudulent scheme" said HHS OIG Special Agent in Charge Shimon R. Richmond. "Billing for work supposedly performed while you were physically in another country is a special kind of arrogance and disregard for the ethical care of patients.”
The United States alleged that Dr. Barbour billed excessively for patient visits at skilled nursing facilities and assisted living facilities, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period. Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit. Records also showed Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code. In addition, billing and travel records demonstrated that Dr. Barbour billed for procedures purportedly performed at Clear Vue while she was out of the country.
The settlement announced today resolves allegations originally brought by Lori Moore, who had worked at Clear Vue, under the qui tam, or whistleblower provisions of the False Claims Act, which permit private individuals to sue on behalf of the government of the United States for the submission of false claims and to receive a share of any recovery. The False Claims Act authorizes the United States to intervene in such lawsuits and take over primary responsibility for litigation. Moore will receive $200,000.
Mr. Ferrer commended the investigative efforts of HHS-OIG. The investigation and settlement were handled by Assistant U.S. Attorney Franklin Monsour.
The case is captioned United States and State of Florida ex rel. Moore v. Clear Vue Eye Center, Inc. and Dr. Monique Barbour, Case No. 14-81099 CIV (S.D. Fla.). The claims settled by the lawsuit are allegations only and there has been no determination of liability.
Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.