Pinellas eye care practice to pay $600K in kickback scheme settlement

Pinellas Eye Care P.A., doing business as Gulfcoast Eye Care, has agreed to pay $615,000 to resolve alleged federal violations of the False Claims Act and a related Florida statute stemming from its billing for certain kinds of ultrasounds through a kickback arrangement with a third party. 

An ophthalmology practice with offices in Pinellas Park, Palm Harbor and St. Petersburg, Gulfcoast Eye has also agreed to cooperate with the Justice Department’s ongoing investigations of other participants in the alleged scheme. The case is a civil settlement filed under the qui tam or whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the government’s recovery. The whistleblower in this case, according to a statement, will receive $116,850 in connection with the settlement.

The settlement resolves allegations Gulfcoast Eye knowingly submitted, and caused the submission of, false claims to Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds, or TCDs. Gulfcoast Eye and a third-party provider of TCD services performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test, the DoJ alleges. 

Officials say that before the patients received the results of the test, Gulfcoast 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. 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. 

Gulfcoast Eye, according to a statement from the U.S. Attorney's office, paid the third-party TCD provider based on the volume or value of tests ordered and referred the patients to the TCD provider’s preferred radiology group for the TCD’s professional component. 

Prosecutors alleged that, as a result of this scheme, Gulfcoast Eye submitted, or caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary, that were premised on false diagnoses and that resulted from violations of the Anti-Kickback Statute and the Stark Law. Of the $615,000 total settlement amount, $602,046 is to be paid to the United States, and $12,953 goes to Florida for its share of Medicaid, which is a jointly funded federal and state program.

“Patients trust their healthcare providers to administer reliable and competent care consistent with their medical needs and ethical standards,” U.S. Attorney for the Middle District of Florida Gregory W. Kehoe says in the statement. “When this relationship is exploited for personal gain or greed, the integrity of our health care system is compromised. We will continue working with our law enforcement partners to protect patients from potential harm and maintain the integrity of our federal programs.”

Trial Attorney Nelson Wagner in the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant United States Attorney Mamie Wise for the Middle District of Florida handled the matter.