Massachusetts Eye Practice and Physician Owner Agree to Pay $350,000 to Resolve False Claims Act Allegations

A Massachusetts eye practice and its physician owner have agreed to pay $350,000 to resolve allegations that they violated the False Claims Act by submitting claims to Medicare and Medicaid for services that were not medically necessary or not properly documented.

The settlement, announced by the U.S. Attorney’s Office for the District of Massachusetts, resolves claims that the practice billed federal healthcare programs for diagnostic testing and office visits that did not meet coverage requirements.

According to the government’s allegations, the practice and its owner submitted claims for ophthalmology services—including diagnostic imaging and eye exams—without the clinical justification required to support reimbursement. In some instances, the services were duplicative of tests the patient had already received, or were performed at a frequency exceeding what medical guidelines recommend.

Because Medicare and Medicaid only pay for services that are medically reasonable and necessary, these claims resulted in improper payments to the practice. The settlement resolves the government’s claims without an admission of liability, though the practice has agreed to cooperate with ongoing compliance monitoring.

This case reflects the government’s sustained commitment to ensuring that healthcare providers bill federal programs accurately and only for services that are medically justified. While this matter was resolved through a civil settlement rather than a qui tam whistleblower action, individuals with knowledge of similar fraudulent billing practices—including unnecessary testing, upcoding, or illegal kickbacks—can pursue remedies under the False Claims Act. Whistleblowers who file qui tam lawsuits on behalf of the government may be entitled to a share of any recovery.

If you have information about Medicare or Medicaid fraud, consulting experienced whistleblower attorneys can help you understand your options and protections.