Court Assesses $170 Million in Penalties For False Claims Against Two Texas Ophthalmologists and Their Clinic
Monday, January 24, 2022
On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.
U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.
A Former Employee Blew the Whistle.According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or "qui tam" suit. The whistle blower was a former employee of the clinic. The suit alleged that between February 2006 and December 2011, the two ophthalmologists fraudulently billed the Medicare Program for single eye pressure measurement tests used to assess and treat glaucoma. In addition, the suit claimed that both physicians allegedly billed the federal health care program using an improper reimbursement code that provided a higher reimbursement than that authorized.
The clinic allegedly submitted 14,450 claims and received $807,450 in payments from Medicare during this time relating to the allegations of fraud.
Assessment of Damages and Penalties.In March 2020, the government won a summary judgment against the Texas clinic. Read more here.
As a result, the judge assessed a treble damages penalty that amounted to $2,422,350. Additionally, Judge Hughes assessed a penalty of $11,803 for each false claim, which is the minimum penalty that could have been assessed under the current version of the statute. According to the press release issued by the DOJ, the court's assessments resulted in a total of $170,553,350 in penalties.
Click here to read more.
To read about an ophthalmologist involved in a similar Medicare fraud scheme, click here to read one of my prior blogs.
Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.The attorneys of The Health Law Firm represent licensed ophthalmologists and other healthcare providers in Medicare audits, integrity audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or Toll-Free at (888) 331-6620.
Sources:Health Law Weekly. "Ophthalmologists Must Pay $170 Million in Penalties." American Health Law Association. (December 3, 2021). Web.
"Court assesses $170 million in penalties against two Houston opthalmologists." Houston Business and Energy Blog. (November 18, 2021). Web.
Paavola, Alia. "Judge orders 2 ophthalmologists to pay $170M for false claims violations." Becker's Hoptial Review. (November 19, 2021). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
KeyWords: Healthcare fraud representation, healthcare fraud defense lawyer, Medicare fraud defense counsel, Medicare fraud defense legal representation, Medicare fraud defense attorney, civil monetary penalty defense counsel, civil monetary penalty defense lawyer, civil monetary penalty litigation defense attorney, attorney for ophthalmologists, ophthalmologist legal representation, legal counsel for ophthalmologists, ophthalmologist legal defense counsel, defense attorney for ophthalmologists, ophthalmologist legal defense representation, Medicare audit defense legal counsel, Office of Inspector General (OIG) Medicare exclusion defense counsel, Medicare audit defense attorney, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, Office of Inspector General (OIG) Medicare exclusion attorney, OIG investigation legal defense representation, OIG exclusion defense attorney, OIG exclusion defense lawyer, Medicare exclusion hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare administrative law judge hearing defense attorney, Medicare and Medicaid audit defense attorney, legal representation for Medicare and Medicaid audits, health care fraud defense attorney, legal representation for health care fraud, Centers for Medicare and Medicaid (CMS), legal representation for CMS investigations, health care professional defense attorney, legal representation for health care professionals, legal representation for fraud investigations, reviews for The Health Law Firm, The Health Law Firm attorney reviews, healthcare fraud representation, allegations of healthcare fraud, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, False Claims attorney, FCA lawyer, FCA attorney, representation for submitting False Claims, representation for overbilling Medicare, medical overbilling, allegations of overbilling Medicaid, FCA defense lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
Like this blog? Add your public comments:
Items in bold indicate required information.