LOCAL COMPANY PAYS $1.3 MILLION TO SETTLE CASE.
Brandon Eye Associates has an office at 105 Southern Oaks Drive in Plant City. According to the company’s web site, its ophthalmologists, “Use their hearts to help care for your eyes” and “are caring healthcare providers whose main priority is the safety and overall well-being of their patients.”
On November 12, Brandon Eye Associates settled with the U.S. Department of Justice (DOJ) to pay $1.3 million for billing fraud. According to the DOJ, “The claims resolved by the settlement are allegations only. There has been no determination of liability.”
According to the Department of Justice, the reason for the settlement is Brandon Eye Associates billing for transcranial Doppler ultrasounds (TCDs) provided a kickback arrangement with another entity. The charges are that Brandon Eye Associates knowingly submitted falsified claims for medically unnecessary TCDs performed on patients. Brandon Eye and the third-party that provides mobile TCD services agreed together to perform TCDs that were not actually needed on Brandon Eye patients who had health conditions like hypertension, diabetes, and/or glaucoma. “Before the patient received the TCD result, Brandon Eye and the third-party provider identified the patients as having received a serious diagnosis—most commonly of occlusion and stenosis of their cerebral arteries—that could qualify the patient for reimbursement of a TCD by Medicare or Medicaid,” the DOJ’s Office of Public Affairs stated in a press release about the matter. “However, nearly all patients who received TCDs never had occlusion and stenosis of cerebral arteries, and that diagnosis was accordingly not reflected in the patient’s medical history or in the TCD results. For each TCD ordered for each Medicare Part B patient, Brandon Eye claimed reimbursement for the technical component of the test, paid the third-party TCD provider based on the volume or value of tests ordered, and referred the patient to the TCD provider’s preferred radiology group for the TCD’s professional component.”
This sort of activity violates the Anti-Kickback Statute, the Stark Law, and the False Claims Act of 1863, which is a federal law that imposes liability on companies and people who commit fraud against government programs. The Act is the federal government’s primary legal tool to fight fraud perpetrated on it. There is an accompanying Florida Statue created in 2003, the Florida False Claims Act, that establishes a way to levy fines and civil penalties. Brandon Eye has agreed to cooperate with the Justice Department’s investigations of other participants in the operation.
“The payment of kickbacks can bias medical decision making, result in unnecessary services, and drive up health care costs at the expense of the American taxpayers,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division said. “Today’s settlement demonstrates that the Justice Department will continue to hold accountable those who enter into kickback arrangements that undermine the integrity of federal health care programs.”
Of the $1.3 million total settlement, $1,210,245.70 will go to the United States, while $89,754.30 will be paid to the State of Florida for its share of Medicaid, since it is jointly-funded by the state and the federal government.
“We are all victims when the Medicare and Medicaid systems taxpayers fund are cheated,” Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office, said. “This is why the FBI vigorously investigates alleged kickback schemes and false billing practices, because it is our mission to protect the American people.”
Brandon Eye Associates other locations are in Sun City, and Brandon.
“Kickback arrangements meant to boost company profits can corrupt the legitimate medical decision-making process and undermine the integrity of federal healthcare programs,” Special Agent in Charge Stephen Mahmood of the Department of Health and Human Services Office of Inspector General (HHS-OIG), said. “HHS-OIG and our law enforcement partners will continue to pursue allegations of improper billing and kickback schemes to protect both Medicare and Medicaid, and those served by those programs.”
Brandon Eye Associates
issued this statement about
the allegations.
Brandon Eye Associates has always been deeply committed to delivering the highest quality care while maintaining ethical standards in every aspect of its practice. The decision to incorporate transcranial Doppler (TCD) testing was made with the intent to enhance patient care, based on thorough documentation and assurances provided by an established industry vendor. This vendor supplied written legal opinions, Medicare documentation, and shared information suggesting that TCD testing had been successfully and appropriately utilized in other ophthalmology practices for years. These materials indicated that TCD testing was medically relevant for ophthalmologists to order and supported the use of specific billing codes, referencing discussions with CMS (Centers for Medicare & Medicaid Services).
Patient safety and well-being have always been our top priority. TCD testing was offered solely to provide valuable diagnostic information that could help prevent strokes and identify blood flow issues potentially impacting ocular health. When a Medicare audit revealed concerns related to reimbursement for the testing, we acted swiftly to discontinue its use and ensure compliance. We have cooperated fully with authorities throughout the investigation and proactively arranged to address any reimbursements due to Medicare.
Our commitment to compliance and excellence in patient care is further demonstrated by our exceptionally high MIPS (Merit-based Incentive Payment System) score from CMS year after year. This federal metric evaluates quality, interoperability, cost efficiency, and improvement activities, and our score places us among the leading ophthalmology practices in the nation.
While the implementation of TCD testing was based on documented assurances from the vendor, we recognize the importance of fortifying our internal review processes. Moving forward, we remain steadfast in our dedication to upholding the highest standards of care, ethical practices, and continuous improvement to serve our patients with integrity and excellence.
