Eye care practice in $615K fraud case responds to allegations

A Tampa Bay eyecare practice that agreed to pay $615,000 to settle civil allegations in what federal prosecutors called a kickback scheme says it “immediately discontinued” using the procedure when a Medicare audit raised concerns about the reimbursement process. A physician with the practice, Dr. Michael Manning, also says “we remain deeply committed to our patients’ well-being and to continuously improving how we deliver care.”

Pinellas Eye Care P.A., which operates under the brand Gulfcoast Eye Care, agreed to the settlement in a False Claims Act Case brought by the U.S. Attorney’s Office for the Middle District of Florida in Tampa. The practice, with offices in Pinellas Park, Palm Harbor and St. Petersburg, knowingly submitted, and caused the submission of, false claims to Medicare and Medicaid for medically unnecessary transcranial doppler ultrasounds, or TCDs, authorities alleged. Gulfcoast Eye and a third-party provider of TCD services performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test, the DoJ contended. 

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Gulfcoast Eye Care, in a statement released May 20, four days after the Department of Justice’s May 16 release, says “the decision to offer TCD testing was made with the intent to provide patients with an additional tool to evaluate their health, particularly as it relates to stroke risk and blood flow issues that may affect vision.” And the decision, the practice adds, was “based on documentation and guidance provided by a third-party medical vendor.” 

Neither the company nor federal officials have publicly identified the third-party vendor. 

That vendor, according to Gulfcoast Eye Care, shared materials including legal opinions, Medicare references and information suggesting TCD testing had been used appropriately in ophthalmology settings for many years. “Based on these materials, the test was presented to us as both medically relevant and appropriately billable,” the company, founded 45 years ago, says. 

In addition to stopping the use of the testing when it learned about the audit, the company says it has also “cooperated fully with all inquiries and have taken proactive measures to address any reimbursement obligations.”

“Our top priority has always been the health and trust of our patients,” the company says in the statement. “While we acted in good faith based on the information provided, we understand the responsibility that comes with being a long-standing provider in this community. We are taking steps to strengthen our internal review process and ensure every decision we make reflects the trust our patients place in us.

Of the $615,000 total settlement amount, $602,046 is to be paid to the United States, and $12,953 goes to Florida for its share of Medicaid, which is a jointly funded federal and state program. The case is a civil settlement filed under the qui tam or whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the government’s recovery. The whistleblower in this case, according to a statement, will receive $116,850 in connection with the settlement.