An optometry practice as agreed to pay the U.S. Government $800,000 to settle a whistleblower lawsuit filed under the federal False Claims Act. The whistleblower suit alleges that the optometry practice employed a optometrist who provided routine eye exams once a month to patients residing in nursing homes. According to the whistleblower complaint, the optometrist performed these eye exams regardless of whether the patient’s medical condition required such medical services. The government alleges that this conduct occurred between 2007 and 2012.
The main argument put forth by the government is that the eye exams performed by the optometry practice were medically unnecessary. These eye exams were reimbursed by Medicare and Medicaid and therefore were paid in violation of the False Claims Act.
The whistleblower complaint alleges that the optometrist would visit local nursing homes on a regular basis and claim to treat over 100 patients in a single. The complaint alleges that on certain dates, these services would have required more than 20 hours’ worth of direct patient care per day, and that the optometrist was not working inside these nursing homes more than 8 hours per day. Due to this, the government alleges that it was not possible for all of the patients to receive a legitimate eye exam, and therefore the eye exam performed has no medical value. The Optometry practice billed for these eye exams, leading to their potential liability under the False Claims Act.
The whistleblower also alleged that the defendants sought payment for routine monthly eye examinations that were unreasonable and unnecessary given the patients’ conditions. Many nursing home patients received an eye examination from the optometrist every four to five weeks for five years or more. At times, he billed Medicare for certain eye examinations more than any other optometrist in the United States.
According to the settlement agreement, in addition to payment of the settlement amount, the Optometry practice has agreed to enter into an integrity agreement with the Department of Health and Human Services-Office of Inspector General, which obligates it to undertake substantial internal compliance reforms and to commit to a third party review of its claims to federal health care programs for the next three years.
The whistleblower filed a lawsuit under United States’ False Claims Act in May 2013. This settlement resolves the government’s claims against Optometry practice, but does not resolve any claims for False Claims Act violations against the optometrist, who is scheduled to begin trial in April 2015 on allegations that he violated the False Claims Act. If found liable under the False Claims Act, he would be responsible for paying back three times the amount of money Medicare and Medicaid paid for his unnecessary and/or worthless services and would be excluded from further participation in federal health care programs.
No Fees Without Recovery
Ross M. Wolfe and the Weiser Law Firm litigate whistleblower lawsuits on a contingent fee basis, so whistleblowers do not pay attorneys’ fees or court costs unless there is a recovery.
Please contact Ross M. Wolfe if you would like to speak with a whistleblower attorney for more information about fraud in government contracts or to schedule a free consultation to confidentially discuss your potential case.