Five Ophthalmology Practices Agree to Pay Nearly $6 Million to Resolve Kickback and False Claims Allegations

Five Florida ophthalmology practices have agreed to pay a combined total of nearly $6 million to resolve allegations that they violated the False Claims Act by billing Medicare and Medicaid for medically unnecessary cranial ultrasounds. The settlements involve Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc.

The government alleged that between January 2018 and June 2022, the practices engaged in a kickback arrangement with a third-party testing company. According to the allegations, the practices paid the testing company based on the volume of tests ordered and referred patients to the company’s preferred radiology group. Before patients received test results, the company identified them as having a serious diagnosis that could qualify for reimbursement, even though nearly all patients never had that diagnosis. As a result, the practices submitted false claims for tests that were medically unnecessary and rooted in violations of the Anti-Kickback Statute and the Stark Law.

This case originated from a qui tam whistleblower lawsuit. Under the False Claims Act, the whistleblower will receive approximately $1.13 million as a share of the federal recovery. The total settlement payments include $2.14 million from Clay Eye Holdings, $1.75 million from Retina Macula Specialist, $1.25 million from Florida Eye Institute, $525,000 from Miami Eye, and $310,000 from Kendall Eye Institute. Of the total, $333,500 will go to the State of Florida for its share of Medicaid funds. Individuals with knowledge of similar kickback arrangements or improper billing practices are encouraged to consult experienced whistleblower attorneys.