Five ophthalmology practices in Florida have agreed to pay nearly $6 million to settle allegations that they submitted false claims to Medicare and Medicaid for trans-cranial doppler ultrasounds (TCDs) as part of a kickback arrangement with a third-party testing company. The practices—Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc.—will also cooperate with the Justice Department’s ongoing investigations into others involved in the scheme.
“Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Combatting such schemes will continue to be a priority for the Justice Department.”
“These settlements are a continuing testament to the United States’ commitment to fight healthcare fraud and ensure that federal healthcare dollars are spent consistently with the law,” said U.S. Attorney Gregory W. Kehoe of the Middle District of Florida.
“Submitting false claims destroys the public’s trust in our federally funded healthcare programs,” said Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office. “Working together with our law enforcement partners, the FBI will continue to prioritize safeguarding the integrity of the nation’s healthcare system and hold accountable those who try to profit from deception.”
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” said Acting Special Agent in Charge Ricardo Carcas of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG, working with our law enforcement partners, will continue to investigate improper billing and kickback schemes to protect both Medicare and Medicaid as well as those served by these programs.”
The settlements resolve accusations that these practices knowingly billed for medically unnecessary TCDs on thousands of patients between January 1, 2018, and June 1, 2022. According to authorities, patients were identified as having serious diagnoses qualifying them for reimbursement before receiving test results; however, most had no such diagnosis documented in their medical records or test outcomes. Payments were allegedly made based on test volume or value ordered by each practice.
The settlement amounts are: Clay Eye Holdings LLC ($2,140,000), Retina Macula Specialist of Miami LLC ($1,750,000), Florida Eye Institute P.A. ($1,250,000), Miami Eye LLC ($525,000), and Kendall Eye Institute Inc. ($310,000). Of this total sum, $333,500 is designated for Florida’s share related to Medicaid.
A whistleblower filed suit under provisions allowing private parties to sue on behalf of the government over false claims; this individual will receive $1,135,250 from these settlements.
These resolutions follow previous similar cases against other eye care providers in Florida. The investigation was carried out by multiple agencies including HHS-OIG and FBI alongside federal prosecutors.
Officials emphasized that these are civil settlements resolving allegations only; there has been no determination regarding liability.
