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

On March , 2022, a New York ophthalmologist was sentenced to 96 months in prison for fraudulently obtaining two government-guaranteed small business loans and for a seven-year fraudulent healthcare billing scheme, the Justice Department announced.

According to the indictment, the former eye doctor was charged with fraudulently obtaining government-guaranteed small business loans under the Paycheck Protection Program (PPP) a COVID-19 relief program.  He was also charged with orchestrating a multi-million-dollar fraud scheme by improperly billing for procedures never performed and upcoding simpler procedures.

The Allegations.

According to the allegations, the former eye doctor, who surrendered his medical license, owned and operated an ophthalmology practice doing business as Rye Eye Associates. Between 2010 and 2017, he regularly “upcoded” simpler, lower-paying surgical procedures and exams as higher-paying major operations in fraudulent billings submitted to Medicare, prosecutors said. He obtained at least $3.6 million as a result of fraudulent billings he submitted to Medicare, private insurance companies and patients, it is alleged.

In addition, while the criminal health care fraud charges were pending and he was out on bond (pre-trial release), he applied for over $630,000 in government loans under the Paycheck Protection Program (PPP).  He then allegedly improperly used the funding for various purposes, including for personal expenses.

The Charges.

The ophthalmologist pled guilty to all six counts in the Superseding Indictment in September 2021.  The first count charged healthcare fraud; the second count charged wire fraud; and the third count charged making false statements relating to health care matters.  Counts four, five, and six charged that while on pretrial release, the defendant committed the following offenses, respectively: bank fraud, making false statements on a loan application, and making false statements in a matter within the jurisdiction of the executive branch of the Government of the United States.

In addition to the prison term, he was sentenced to five years of supervised release, and ordered to pay a forfeiture of $3.6 million and restitution of $3.6 million.  Approximately $1.79 million toward these obligations has already been paid back.

To read the press release from the Department of Justice (DOJ), click here.

For more information on this case, click here to read my prior blog.

COVID-19 Relief Programs a Big Source of Fraud and False Claims.

It turns out that COVID-19 relief programs, designed to be quick, easy and efficient, are the source of much fraud.  Dishonest individuals filing false documents and claims have run up false claims into the millions.  What few people understand is that these are false government claims. Therefore, the False Claims Act (Qui Tam Act) applies to them, too.  Employees and others who know of false claims or false documents being filed for such loans and grants from the government, or to improperly bill for services, have the right to file a whistleblower law suit (qui tam action) or claim and receive a portion of any money the government recovers.

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.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robertson, Marcus. “Ophthalmologist gets 8 years in prison for surgical billing scheme and COVID-19 fraud.” Becker’s Hospital Review. (March 4, 2022). Web.

Health Law Weekly. “Ophthalmologist Draws Eight-Year Prison Sentence for Improper Billing, COVID-19 Loan Fraud.” American Health Lawyers Association (AHLA). (March 11, 2022). 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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