Manhattan U.S. Attorney Announces $2 Million Settlement Of Health Care Fraud Claims Against Metropolitan Retina Associates, Inc., And Dr. Kenneth Felder
Metropolitan Retina Associates and Dr. Felder Admit to Billing Medicare and Medicaid for Worthless and Unsubstantiated Imaging Studies of the Eye
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Scott J. Lampert, Special Agent in Charge for the New York Office of Inspector General of the U.S. Department of Health and Human Services (“HHS-OIG”), announced today a settlement of a civil fraud lawsuit against DR. KENNETH S. FELDER (“FELDER”) and METROPOLITAN RETINA ASSOCIATES, INC. (“METROPOLITAN RETINA”). The settlement resolves claims under the False Claims Act alleging that FELDER and METROPOLITAN RETINA billed Medicare and Medicaid for (1) substandard fluorescein angiography tests that were of such poor quality that they lacked all diagnostic value and were effectively worthless; and (2) ophthalmic ultrasounds that were either not performed or lacked any supporting documentation. Under the terms of the settlement approved by U.S. District Judge Alison J. Nathan, FELDER and METROPOLITAN RETINA admitted and accepted responsibility for their conduct and agreed to pay $2,064,559 to the United States.
Manhattan U.S. Attorney Geoffrey S. Berman said: “Dr. Kenneth Felder and Metropolitan Retina defrauded taxpayers when they billed Medicare and Medicaid for diagnostic tests that were shoddy, undocumented, and sometimes not performed at all. This settlement sends a strong message that such conduct will not be tolerated.”
HHS-OIG Special Agent in Charge Scott J. Lampert said: “The irresponsible behavior by Metropolitan Retina Associates and Dr. Kenneth Felder compromised the integrity of the Medicare and Medicaid programs, and wasted millions of taxpayer dollars. HHS-OIG will continue to ensure that providers who do business with federally funded health care programs do so in an honest fashion.”
METROPOLITAN RETINA is an ophthalmology practice that is wholly owned by FELDER, with offices in Brooklyn and Manhattan. As part of the settlement, FELDER and METROPOLITAN RETINA admit, acknowledge, and accept responsibility for the following conduct:
- FELDER and METROPOLITAN RETINA frequently submitted claims to Medicare and Medicaid for fluorescein angiograms that lacked any diagnostic or medical value because the images were distorted and/or were taken from angles that made it impossible to evaluate the patients’ conditions.
- Medicare or Medicaid would not have paid for these procedures had they known that the fluorescein angiograms lacked any diagnostic or medical value.
- FELDER and METROPOLITAN RETINA frequently submitted claims to Medicare and Medicaid for ultrasounds of the eye that either were not performed or were not supported by any medical record documentation.
- Medicare and Medicaid would not have paid for these ultrasounds had they known that the ultrasounds either were not performed or were not supported by documentation in the medical records.
- As a result of billing for the medical procedures described above, FELDER and METROPOLITAN RETINA received substantial reimbursement from Medicare and Medicaid to which they were not entitled.
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Mr. Berman thanked the Office of the Inspector General for HHS for its assistance.
The case is being handled by the Office’s Civil Division. Assistant U.S. Attorneys Brandon Cowart and Jacob M. Bergman are in charge of the case.