Clay Eye Holdings LLC has agreed to a settlement involving nearly $6 million in payments, along with four other ophthalmology practices in Florida, as a result of a whistleblower lawsuit.
JACKSONVILLE, Fla. — The eye-care business based in Fleming Island has consented to pay $2.1 million to resolve allegations of submitting inappropriate claims for unnecessary ultrasound procedures to Medicare and Medicaid, as announced by the U.S. Justice Department.
The settlement is part of a broader agreement involving five ophthalmology practices statewide, collectively contributing to nearly $6 million in payments connected to a whistleblower’s lawsuit. The lawsuit claimed these firms breached the federal False Claims Act, according to a statement released on January 15 by the U.S. Attorney’s Office for the Middle District of Florida, which encompasses Jacksonville.
Enacted in the 19th century, the False Claims Act is frequently invoked in cases where businesses are suspected of engaging in kickbacks that inflate costs to government services such as Medicare, the health care program for seniors.
“Kickbacks and false claims drive up healthcare costs for everyone and compromise the integrity of healthcare decision-making,” remarked Assistant Attorney General Brett A. Shumate from the Justice Department’s Civil Division in the official statement.
Interestingly, the federal courts’ Pacer system, which tracks legal proceedings, does not show any cases involving Clay Eye Holdings.
The Justice Department announcement said the eye-care firms’ payments resolved issues “arising from their billing for trans-cranial doppler ultrasounds (TCDs) through a kickback arrangement” with an unnamed third-party testing company.
“… The United States alleged that as a result of this scheme, the settling practices submitted … false claims to Medicare and Medicaid for TCDs … that were medically unnecessary, [and] that were premised on false diagnoses,” the Justice release said.
Trans-cranial doppler ultrasound tests use sound waves to find conditions, like strokes, affecting blood flow in the brain. Some eye-care providers use the test to examine patients with conditions including migraines, blurred or double vision and some types of glaucoma.
But the Justice release suggested concern the test was being used excessively, saying the firms in the settlements “performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test.
“Before the patients received the results of the test, the practices and the third-party testing company identified the patients as having received a serious diagnosis that could qualify the patient for reimbursement of a TCD by Medicare or Medicaid” the release said. “However, nearly all patients who received TCDs never had that diagnosis, and it was not reflected in the patient’s medical history or in the TCD results.”
Editor’s note: This story was first published by our news partners, The Florida Times-Union.
