A prominent ophthalmology practice serving residents in Vero Beach, Sebastian, and Fort Pierce has agreed to a significant financial settlement to resolve federal allegations involving fraudulent billing. Florida Eye Institute P.A. is one of five Florida-based eye care groups that collectively agreed to pay nearly $6 million to settle claims that they billed Medicare and Medicaid for medically unnecessary tests.
According to a recent announcement from the U.S. Department of Justice, Florida Eye Institute will pay $1,250,000 as part of the resolution. The allegations centered on violations of the False Claims Act, specifically related to billing for trans-cranial doppler (TCD) ultrasounds. Authorities alleged that these billings were part of a kickback arrangement with a third-party testing company.
Understanding the Allegations
Between January 1, 2018, and June 1, 2022, the practices reportedly performed ultrasounds on thousands of patients, billing government healthcare programs hundreds of dollars for each test. A trans-cranial doppler ultrasound is a non-invasive diagnostic tool that uses sound waves to measure blood flow in the brain’s major arteries, typically used to help diagnose strokes or blockages.
However, the Department of Justice alleged that the testing was often not medically necessary. The government claimed that the practices and a third-party company identified patients as having serious diagnoses that would justify reimbursement before the patients had even received their test results.
Nearly all patients who received the ultrasounds never had the diagnosed condition, and the serious diagnoses were not reflected in either the patients’ medical histories or the results of the ultrasounds themselves.
The investigation revealed that the practices paid the third-party testing company based on the volume or value of the tests ordered. Furthermore, patients were referred to a radiology group preferred by the testing company for the professional component of the ultrasounds.
Settlement Breakdown and Ongoing Cooperation
While the Florida Eye Institute—which operates local offices in Vero Beach and Sebastian—agreed to the $1.25 million payment, other practices across the state were also involved in the settlement. The agreements resolve the civil liability without an admission of guilt, but all five practices have agreed to cooperate with ongoing federal investigations into other participants in the alleged scheme.
The specific settlement amounts for the five practices are as follows:
Whistleblower and State Recovery
The case was brought to light through a lawsuit filed under the qui tam, or whistleblower, provision of the False Claims Act. This law allows private citizens to file suits on behalf of the United States regarding false claims and to share in a portion of the recovery.
In this instance, the whistleblower who filed the complaint will receive approximately $1,135,250 from the total settlement proceeds. Additionally, because Medicaid is a jointly funded program, $333,500 of the total settlement amount will be returned to the State of Florida.
