Eye Doctor Fraud and the False Claims Act

Whistleblowers may report fraud in eye care by optometrists, ophthalmologists and other eye care professionals to the U.S. Government, the Department of Justice and the Centers for Medicare and Medicaid Services. The False Claims Act rewards eligible individuals with evidence of fraud with a portion of the government’s recovery.

Our whistleblower attorneys provide strategic guidance and legal representation to False Claims Act clients. For a free, confidential, no obligation initial consultation with one of our whistleblower attorneys, please call 1-800-590-4116.

About Eye Care Fraud

The U.S. Government pays for eye care for current and retired federal employees, the elderly, and low income Americans. Medicare Part B program, Medicaid and various other federal programs can be billed for the treatment of patients by optometrists, ophthalmologists, and other providers of eye care health services. When these practices bill the government for treatments that are unnecessary or not actually performed, the government is able to reclaim its lost funds through the False Claims Act.

A 2012 study by the Office of the Inspector General (OIG) found that claims for payment for opthalmology services to screen, diagnose, evaluate and treat cataracts, wet age-related macular degeneration (wet AMD), and glaucoma are vulnerable to fraud, waste, and/or abuse. The government spends roughly $8 billion a year to diagnose and treat these conditions from Medicare funds. The study found approximately $22 million in payments that should not have been made under the terms of the program.

– False billing for special eye pressure tests on Medicare patients.
– Unnecessary laser eye procedures for the treatment of glaucoma or macular degeneration.
– Billing for Eye Examinations on Nursing Home Patients when short or no examinations were performed.
– Use of certain billing diagnostic codes such as diabetes in order to improperly upcode bills.
– Unnecessary Opthalmic Diagnostic Imaging.

If you have evidence that an eye care provider is engaged in fraud against the U.S. Government through one of the above methods, please call our whistleblower attorneys at 1-800-590-4116.

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