BRANDON, Fla. — A Florida ophthalmology practice has agreed to pay $1.3 million to resolve allegations of submitting fraudulent Medicare and Medicaid claims.
Brandon Eye Associates P.A., which operates in Brandon, Sun City, and Plant City, has settled claims that it violated the False Claims Act and a similar Florida statute by improperly billing for trans-cranial doppler ultrasounds (TCDs) through an alleged kickback arrangement. According to the U.S. Department of Justice, the practice is accused of knowingly submitting claims for medically unnecessary TCDs based on false diagnoses.
The allegations, outlined in court documents, claim that Brandon Eye and a third-party provider performed TCDs on patients with common conditions like diabetes, hypertension, and glaucoma. The United States alleged that, before the test results were available, patients were diagnosed with serious conditions such as cerebral artery occlusion and stenosis, which qualified the procedures for Medicare or Medicaid reimbursement.
However, the government contended that these diagnoses were rarely supported by the patient’s medical histories or the TCD results, making the claims fraudulent.
Additionally, Brandon Eye allegedly compensated the third-party provider based on the volume or value of tests ordered and referred patients to a preferred radiology group for professional interpretation. These practices are said to have violated the Anti-Kickback Statute and Stark Law.
The $1.3 million settlement includes $1,210,245.70 for the United States and $89,754.30 for Florida’s Medicaid program. Brandon Eye has agreed to cooperate with ongoing investigations into other participants in the alleged scheme.
“This settlement demonstrates our commitment to holding providers accountable for exploiting federal healthcare programs,” said U.S. Attorney Roger Handberg for the Middle District of Florida.
