By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On May 16, 2025, Florida-based Pinellas Eye Care, P.A., also known as Gulfcoast Eye Care, agreed to pay $615,000 to settle claims of alleged violations of the False Claims Act (FCA). The allegations involve billing for trans-cranial doppler ultrasounds (TCDs) that were done as part of an illegal kickback arrangement with a third party, according to U.S. Attorney for the Middle District of Florida Gregory W. Kehoe. The settlement was recently announced by the federal government.
The Government’s Allegations.
The settlement addressed claims that Gulfcoast Eye Care knowingly submitted and caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary. According to the government, Gulfcoast Eye Care and a third-party provider performed TCDs on thousands of patients, billing Medicare and Medicaid hundreds of dollars per test. It was alleged that before patients ever received the test results, Gulfcoast Eye Care and the third-party provider identified them as having a serious diagnosis. The most common diagnoses made were occlusion and stenosis of the cerebral arteries, which could qualify the patients for Medicare or Medicaid reimbursement for a TCD.
However, the government claimed, the majority of patients undergoing TCDs did not have the cerebral artery occlusion or stenosis that the tests were meant to detect, a discrepancy not reflected in their medical records. The United States also alleged that Gulfcoast Eye Care compensated the TCD company based on the number of tests ordered and referred patients to the TCD company’s preferred radiology group.
As a result of this scheme, the government claimed that Gulfcoast Eye Care submitted false claims to Medicare and Medicaid for medically unnecessary TCDs based on incorrect diagnoses, in violation of the Anti-Kickback Statute (AKS) and the Stark Law.
The Settlement Details.
The settlement resolved a lawsuit filed under the qui tam or whistleblower provision of the FCA. This provision permits private parties to file suit on behalf of the United States for false claims and share in a portion of the Government’s recovery. The qui tam was filed by a whistleblower who will receive $116,850 in connection with the settlement.
The agreement requires Gulfcoast Eye Care to pay $602,046 to the United States and an additional $12,953 to the State of Florida, representing Florida’s share of the Medicaid program. Furthermore, Gulfcoast Eye Care has pledged cooperation with the Justice Department’s ongoing investigations into other participants in the alleged scheme.
For more information, read the press release from the U.S. Attorney’s Office, Middle District of Florida.
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Sources:
American Health Law Association. “Ophthalmology Practice Agrees to $615,000 Settlement of Medicare, Medicaid False Claims Allegations.” Health Law Weekly. (May 16, 2025). Web.
U.S. Department of Justice (DOJ). “Florida Ophthalmology Practice Agrees To Pay $615,000 To Resolve Allegations Of Fraudulent Claims To Medicare And Medicaid For Cranial Ultrasounds.” U.S. Attorney’s Office, Middle District of Florida. (May 16, 2025). Web.
Masters, Melissa. “Pinellas Eye Care, P.A. To Pay $615K To Settle False Claims Allegations In Kickback Scheme.” Pinellas Free Press. (May 20, 2025). 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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