Eye Practice and Its Physician Owner Agree to Pay More Than $460,000 to Resolve Allegations of False Claims and Receiving Illegal Kickbacks

BOSTON – Burlington County Eye Physicians (BCEP), an ophthalmology practice with locations in New Jersey and Pennsylvania, and Dr. Gregory H. Scimeca, an ophthalmologist and the owner of BCEP, have agreed to pay $469,232 to resolve allegations that they submitted and caused the submission of false claims for payment for medically unnecessary transcranial doppler (TCD) tests to Medicare and the Federal Employee Health Benefit (FEHB) Program in violation of the False Claims Act. 

A TCD test is a noninvasive diagnostic test that can be used to estimate the blood flow through certain blood vessels in the brain. Medicare and the FEHB Program reimburse healthcare providers for both performing the test and for interpreting the test results. When a physician does not perform the test, but interprets the results of the test, they only can bill for their professional services of interpreting the test. A physician cannot bill for interpreting the test when they merely review another physician’s interpretation of the results.  

As part of the settlement agreement, BCEP and Dr. Scimeca each admitted to and accepted responsibility for facts underlying the covered conduct. The United States alleges that from May 13, 2019 through Feb. 22, 2021, BCEP submitted and caused the submission of false claims for TCD tests to Medicare and the FEHB Program. BCEP contracted with a medical diagnostics company (the “Company”) to perform TCD tests on BCEP patients. The Company staffed BCEP with a technician, who reviewed patient files and filled out forms to order TCD tests for BCEP patients from the Company. BCEP physicians, including Dr. Scimeca, signed the order forms the Company’s technician completed. At times, BCEP and Dr. Scimeca signed forms which indicated that patients had a diagnosis that they did not have, but that would have supported the medical necessity of the test. In addition, BCEP paid $30 to either the Company or a radiology company associated with the Company to interpret each TCD test, but BCEP physicians, including Dr. Scimeca, also billed Medicare and the FEHB Program for interpreting those tests. 

The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare and other federally-funded programs. The statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.  

The United States contends that the claims for TCD tests that BCEP and Dr. Scimeca submitted, or caused the submission of, were false because: (1) the TCD tests were medically unnecessary because the patients did not have symptoms justifying the need for the tests, or the tests were not necessary for the patients’ treatment; (2) BCEP and Dr. Scimeca billed for professional services that they did not perform; and (3) the arrangement between BCEP and the TCD company violated the AKS because BCEP and Dr. Scimeca accepted remuneration from the Company by billing for and retaining payments from Medicare and the FEHB Program for services that the Company provided.

“Health care practitioners must not bill for services they do not perform or bill for unnecessary procedures. Full stop. When they do, they violate the law. These defendants also accepted unlawful kickbacks, which all too often corrupt medical judgment and result in unnecessary medical tests,” said Acting United States Attorney Joshua S. Levy. “As this case demonstrates, our office is committed to investigating and holding accountable both the recipients of kickbacks and the companies paying them.”

“When health care providers submit claims for services to the Medicare program, those services are expected to be medically necessary, actually performed, and free from the influence of illegal kickbacks,” said Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General. “The integrity of our federal health care system is undermined when those expectations are not met, and we will continue to thoroughly pursue such allegations.”

The resolution announced today includes claims that were brought under the qui tam or whistleblower provisions of the False Claims Act. Under the Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of today’s resolution, the whistleblower will receive approximately $84,460.

Acting U.S. Attorney Levy and HHS-OIG SAC Coyne made the announcement today. Valuable assistance was provided by the U.S. Office of Personnel Management. Assistant U.S. Attorneys Jessica J. Weber and Christopher Morgan of the Affirmative Civil Enforcement Unit handled this matter.