New York Eye Doctor Arrested for $8 Million Medicare Fraud Scheme
Monday, November 25, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 22, 2019, the United States Attorney for the Southern District of New York Announced the indictment and arrest of an ophthalmologist for healthcare fraud. According to federal prosecutors, the eye doctor billed patients and insurance companies for millions of dollars for surgeries that he never performed from 2010 to 2017. Prosecutors also announced that they will sue his practice, The Eye Associates Group, in civil court under the False Claims Act (FCA).
The Indictment.
The indictment charges the ophthalmologist with fraudulently billing patients, Medicare, and private insurance programs millions of dollars for complex eye surgeries that were never performed. The Civil Complaint further alleges that the eye doctor and his practice engaged in fraud by consistently “upcoding” surgical procedures, examinations, and tests in fraudulent billings submitted to Medicare and Medicaid. As alleged, he also falsified patient medical records, pressured other employees to engage in the scheme, and initiated debt collection proceedings against patients who did not pay the full amounts of his fraudulently billed charges.
The fraudulent scheme allegedly raked in more than $8 million between January 2010 and March 2017.
The physician is charged with three counts in the indictment. The first count charges healthcare fraud, which carries a maximum sentence of 10 years in prison; the second count charges wire fraud, which carries a maximum sentence of 20 years in prison; the third count charges making false statements relating to health care matters, which carries a maximum sentence of five years in prison.
To read the press release issued by the DOJ, click here.
Never Make False Statements of Any Kind to Any Federal Official or Investigator.
We are seeing more and more federal cases brought alleging "making false statements to investigators." This is an easy mistake for a person to make. It is also very easy to prove it and it is a felony. The criminal offense is a violation of 18 U.S.C. 1001, often called a "1001 violation." The person does not need to be under oath to commit the violation. The statement can be an oral statement or a written statement. Regardless of the possibility of committing a felony for making a false statement, you should never be in the position of providing false information to the government, anyway.
One of the main reasons to hire an attorney is so that you do not have to deal directly with any federal agent, employee or investigator. The attorney can deal with the investigators and prosecutors for you. Furthermore, an attorney can advise you when it is best to just shut up and say nothing, which is often the preferred course to take.
Health Care Fraud Should Never Be Taken Lightly.
We have been consulted by many healthcare professionals, both before and after criminal convictions for fraud or related offenses. In many cases, those subject to Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.
Click here to read one of my previous blog posts regarding Medicare audits.
The government is serious about combating health care fraud. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.
If you are accused of Medicare fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.
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 healthcare providers in Medicare audits, ZPIC 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 (850) 439-1001.
Sources:
Eberhart, Christopher. “Eye doctor billed patients, Medicare for over $8M for surgeries he never performed: Feds.” USA Today. (November 22, 2019). Web.
Oliver, Eric. “New York eye doctor arrested for $8M+ in alleged Medicare fraud.” Becker’s Hospital Review. (November 22, 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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11/25/2019
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