Pinellas (Fla.) Eye Care, doing business as Gulfcoast Eye Care, agreed to pay $615,000 to resolve allegations it violated the False Claims Act and Stark law for its billing practices for transcranial doppler ultrasounds, the Justice Department said in a May 16 news release.
What happened?
- The settlement resolves claims the practice submitted false claims to Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds.
- Gulfcoast Eye and a third-party provider performed thousands of the tests and billed Medicare and Medicaid hundreds of dollars per test. Before test results were shared with patients, the providers diagnosed them, often falsely, with conditions like cerebral artery occlusion and stenosis to justify reimbursement. Most patients did not have these conditions, and the diagnoses were not supported by their medical histories or test results.
- Gulfcoast Eye paid the third-party provider based on test volume and referred patients to the physician’s preferred radiology group. The U.S. government alleged this scheme resulted in false claims for medically unnecessary TCDs, involved false diagnoses and violated the Anti-Kickback Statute and Stark law.
- Gulfcoast Eye has agreed to cooperate with the Justice Department’s ongoing investigations of other participants in the alleged scheme.
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