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.

The False Claims Act

The False Claims Act imposes substantial penalties on doctors, hospitals and other health care companies engaged in fraud while rewarding whistleblowers for providing evidence of the misconduct to the Justice Department through a qui tam lawsuit.

Our Federal False Claims Act lawyers have guided whistleblower cases to several significant settlements on behalf of relators. Our largest unsealed cases are currently focused on kickbacks in violation of the Anti-Kickback Statute, but we have a broad base of experience across other types of Medicaid and Medicare fraud. In the pursuit of suspected frauds, we have brought cases to the attention of the government in many states, including New York, Florida, California and here in Philadelphia. In 2016, for example, we helped the federal and state governments recover $54 million from a Valeant subsidiary for kickbacks paid through speaker programs.

The law rewards whistleblowers for information with between 15 and 30 percent of the proceeds from the litigation, subject to numerous terms and conditions specified in the law. During President Obama's Administration, the U.S. paid out more than $4 billion to whistleblowers. For those not familiar with whistleblower cases, we have written a quick guide to the process.

Our False Claims Act attorneys undertake a thorough review of whistleblower evidence up front during the case evaluation process. We confirm that there is sufficient evidence of both inappropriate government billings as well as evidence of intentional or reckless conduct by the individuals in charge. We understand that no one person needs to have every piece of the puzzle and we have evaluated thousands of potential cases while honing our judgment. We also answer any questions that a whistleblower has in order to ensure that you can make an informed judgment about whether to proceed with a qui tam lawsuit.

To begin the process and get your questions answered, use our contact form or call 1-800-590-4116 for a free, confidential and no-obligation initial legal consultation from our whistleblower attorneys.

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