Tampa, FL – Gulfcoast Eye Care, an ophthalmology practice with locations in Pinellas Park, Palm Harbor, and St. Petersburg, has agreed to pay $615,000 to settle allegations of violating the False Claims Act and a similar Florida statute. The allegations involve improper billing for trans-cranial doppler ultrasounds (TCDs) conducted through a kickback arrangement with a third-party provider.
The settlement addresses claims that Gulfcoast Eye knowingly submitted false claims to Medicare and Medicaid for medically unnecessary TCDs. It is alleged that Gulfcoast Eye, in collaboration with a third-party TCD service provider, conducted these tests on thousands of patients, subsequently billing Medicare and Medicaid substantial amounts per test. Before patients received their test results, they were often incorrectly diagnosed with conditions, such as occlusion and stenosis of cerebral arteries, to qualify for Medicare or Medicaid reimbursement. However, the majority of these patients did not have such conditions, which were not reflected in their medical history or TCD results.
According to the allegations, Gulfcoast Eye compensated the third-party provider based on the volume or value of tests ordered and referred patients to a preferred radiology group for the TCD’s professional component. This arrangement allegedly violated the Anti-Kickback Statute and the Stark Law, leading to the submission of false claims.
Out of the total settlement amount, $602,046 will be paid to the United States, and $12,953 will be paid to the State of Florida for its share of Medicaid, a jointly funded federal and state program. The settlement also resolves a lawsuit filed under the qui tam or whistleblower provision of the False Claims Act, allowing private parties to sue on behalf of the United States for false claims and share in the government’s recovery. The whistleblower in this case will receive $116,850.
This resolution results from a coordinated effort involving the Civil Division’s Commercial Litigation Branch, the Fraud Section, the U.S. Attorney’s Office for the Middle District of Florida, the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the FBI. The case underscores the government’s commitment to combating healthcare fraud, with the False Claims Act serving as a crucial tool in this effort.
Authorities encourage the public to report potential fraud, waste, abuse, and mismanagement to HHS at 1-800-HHS-TIPS (800-447-8477). The claims resolved by this settlement are allegations only, with no determination of liability.
