Eye care provider sentenced to federal prison for Medicare and Medicaid fraud

GAINESVILLE, Ga. - Matilda Lynn Prince has been sentenced to federal prison, after a jury convicted her of twenty-nine counts of healthcare fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients.

“Prince will now spend time in federal prison for stealing over a million dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak.  “Prince diverted critical resources away from the elderly and low-income families who were most in need of care.”

“This sentence sends a clear-cut message to crooked providers who fraudulently bill government health care programs,” said Derrick L. Jackson, Special Agent in Charge for the U.S. Department of Health & Human Services - Office of Inspector General (OIG).  “The OIG and our law enforcement partners will continue to aggressively pursue these thieves to ensure they are held accountable.”

“Our Medicaid Fraud Control Unit remains committed to working with our federal partners to investigate and prosecute providers who attempt to steal from healthcare programs designed to provide treatment and care for those most in need,” said Georgia Attorney General Chris Carr.

According to U.S. Attorney Pak, the charges and other information presented in court:  Prince owned Pickens Eye Clinic in Jasper, Georgia and operated Eye Gallery 20/20 in Calhoun, Georgia. From September 2011 to February 2014, Prince submitted false claims to Medicare and Medicaid for optometry and ophthalmology services that were never rendered to patients.

Despite being previously excluded from the Medicare and Medicaid programs in September 2011 and informed of her ineligibility to be employed or involved with any entity that received Medicare or Medicaid funds, Prince operated under a company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered.  As part of the scheme, Prince targeted her advertising towards senior citizens and disabled populations in housing complexes and community centers, offering on-site eye exams and prescription glasses at no charge to patients on Medicare and Medicaid. Prince contracted with two licensed optometrists to provide basic eye exams.  The optometrists would sometimes travel with Prince to perform these exams.

Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures involving the surgical insertion of medical devices called “punctal plugs” into patients' tear ducts to treat dry eye conditions.  Prince then used the identities of the two licensed optometrists to bill Medicare and Medicaid repeatedly for this procedure.  On some occasions, she billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed.  Prince fraudulently submitted over $1.2 million in insurance claims to Medicare and Medicaid for services never rendered.

Matilda Lynn Prince, 42, of Mineral Bluff, Georgia was sentenced to three years, four months in prison, to be followed by three years of supervised release on August 22, 2018.  She was also ordered to pay restitution in the amount of $609,000. Prince was found guilty by a jury on January 9, 2018.

This case was investigated by the Department of Health and Human Services - Office of the Inspector General, and the Georgia Medicaid Fraud Control Unit.

Assistant U.S. Attorneys Bernita B. Malloy and Randy S. Chartash prosecuted the case.

For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016.  The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.