Somerset Optometry Practice To Pay U.S. Government $800,000 To Settle False Claims Act Violations

LONDON, KY - An optometry practice in Pulaski County has agreed to pay the U.S. Government $800,000 to settle civil allegations that it billed federal health care programs for medically unnecessary and worthless eye examinations provided to nursing home residents over the course of several years.

The U.S. Government contends that from January 1, 2007 to January 31, 2012, Associates in Eye Care P.S.C. (“AEC”), employed an optometrist, Dr. Philip Robinson, who provided routine, monthly eye examinations to almost all of his nursing home patients, regardless of their condition or medical need. Many of these examinations were medically unnecessary according to the government’s allegations.

“Federally funded healthcare programs provide an essential safety net for many of our most vulnerable citizens,” said Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky. “Those who abuse the system for personal gain jeopardize the programs on which so many rely. We are committed to using every available tool to protect these vital programs from fraud and abuse.”

The government also alleges that because of the high number of patients seen by Robinson on a daily basis, it was not possible for all of the patients to receive a legitimate eye exam. Therefore, the exams had no medical value. AEC billed Medicare and Medicaid for all eye examinations provided by Robinson to nursing home patients and received payment from those programs.

According to the settlement agreement, AEC violated the False Claims Act by knowingly seeking payment from federal health care programs for unnecessary and/or worthless medical services.

In addition to payment of the settlement amount, AEC has agreed to enter into an integrity agreement with the Department of Health and Human Services-Office of Inspector General (HHS-OIG), 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.

Dr. Robinson is also a defendant in the United States’ False Claims Act complaint filed in May 2013. This settlement resolves the government’s claims against AEC, but does not resolve any claims for False Claims Act violations against Robinson. Robinson’s trial is scheduled to begin in April 2015. If he is found liable, Robinson 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.

The investigation was conducted by the Department of Health and Human Services, Office of the Inspector General; the Office of the Kentucky Attorney General, Medicaid Fraud and Abuse Control Unit (“MFCU”), and the U.S. Attorney’s Office.