Ophthalmic Consultants of Boston, Inc. has agreed to pay $3,902,588.28 to resolve allegations that it falsely billed federal healthcare programs, according to a July 29 announcement by the U.S. Attorney for the District of Massachusetts.
Between Jan. 1, 2015 and July 30, 2025, Ophthalmic Consultants of Boston (OCB) submitted claims to Medicare and MassHealth for office visits during which ophthalmologists administered intravitreal injections. The government said that Medicare and MassHealth do not allow billing for office visits in addition to billing for the injections themselves except under special circumstances. OCB used a special billing code (Modifier 25) even when there was no documentation supporting the extra charge.
The settlement gives OCB credit for cooperation under Department of Justice guidelines regarding voluntary disclosure, cooperation, and remediation in False Claims Act matters. The case was brought under the whistleblower or qui tam provisions of the False Claims Act; private parties may sue on behalf of the government and receive a share of any recovery. In this case, “the relator will receive a share from the proceeds of the settlement.” The lawsuit is captioned United States, et al., ex rel. John Doe v. Ophthalmic Consultants of Boston, Inc., et al., 24-cv-11495.
U.S. Attorney Foley and Roberto Coviello, Special Agent in Charge at Health and Human Services-Office of Inspector General, made the announcement on July 29. Assistant U.S. Attorney Steven Sharobem from the Affirmative Civil Enforcement Unit is handling the case.
The U.S. Attorney for the District of Massachusetts enforces federal laws through prosecutions including national security threats and civil rights violations; serves all residents across Massachusetts with offices in Boston’s John Joseph Moakley United States Federal Courthouse as well as Springfield and Worcester; employs over 200 attorneys, paralegals and professional staff; advances community initiatives on civil rights and violence prevention; operates as part of the United States Department of Justice; and represents more than four hundred member companies statewide, according to its official website.