Florida Eye Doctors Agree to Pay Over $157,000 To Settle FCA Allegations

Wednesday, March 27, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 5, 2019, two Lake County, Florida, ophthalmologists agreed to a six-figure payment for improperly billing Medicare for eyelid repair surgeries, the U.S. Attorney’s Office announced. The pair operates Fishman & Sheridan eyeCare Specialists, and will pay $157,312.12 to resolve allegations they violated the False Claims Act (FCA), according to prosecutors, according to the government.


Improper Billing Procedures.

The two eye doctors agreed to a settlement that relates to their billing at the same time for two different procedures, blepharoplasty and ptosis.  According to prosecutors, they are mutually exclusive eyelid repair surgeries that usually should not be billed simultaneously. The settlement  states that from April 11, 2011, through March 31, 2017, the eye doctors each regularly billed for simultaneously performing blepharoplasty and ptosis on patients and submitted those claims to the United States for reimbursement.


The Whistleblower Suit.

The lawsuit was originally filed in the United States District Court for the Middle District of Florida by two whistleblowers under the qui tam, or whistleblower, provisions of the False Claims Act. The whistleblowers in this case will receive $26,000 of the proceeds from the settlement. The claims resolved by the settlement are allegations only, and the Florida eye doctors have admitted no liability.

Click here
to read the press release issued by the DOJ.

To read about a similar case of a Florida eye doctor in trouble over Medicare fraud, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent retina surgeons and ophthalmologists on many different legal issues.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, optometrists, ophthalmologists, medical groups, clinics, pharmacies, nursing homes, and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. They also represent both whistle blowers and defendants in qui tam (False Claims Act) cases.  To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.


Sources:

Fallstrom, Jerry. “Lake County eye doctors agree to $157K payment to settle Medicare billing allegations.” Orlando Sentinel. (February 5, 2019). Web.

“Clermont Eye Doctors Agree To Pay Over $157,000 To Settle False Claims Act Liability For Improperly Billing Medicare.” Healthcity News. (February 13, 2019). 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., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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3/27/2019

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