Tampa, FL – United States Attorney Maria Chapa Lopez announces that Ophthalmic Consultants, P.A. (Sarasota, FL) and Dr. Robert K. Snyder– collectively, Ophthalmic Consultants – has agreed to pay $4.8 million to resolve allegations of healthcare fraud. Specifically, the government alleged that Ophthalmic Consultants had submitted false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) for treatments using the drugs ranibizumab (Lucentis®) and aflipercept (Eylea®) to treat patients who had wet age-related macular generation or other diseases of the eye. Although each vial contains a moderate overfill, Lucentis and Eylea are single-use medications that are not designed for multiple uses. Notwithstanding the single-use nature of Lucentis and Eylea, Ophthalmic Consultants engaged in the practice of multi-dosing (using a single drug vial to provide doses to multiple patients) to obtain excessive reimbursements from Medicare, TRICARE, and FEHBP.
“Anyone who seeks to exploit our healthcare system by submitting false claims to our federal health care programs will be held accountable for their actions,” said U.S. Attorney Maria Chapa Lopez. “Today’s settlement makes clear that the protection of our nation’s health programs is a priority for our Office and the Department of Justice.”
“Health care providers seeking to enrich themselves by submitting false claims to government health care programs will be held accountable for their actions,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG. “Our agents and attorneys, coordinating closely with our law enforcement and DOJ partners, will continue working hard to protect the Medicare and Medicaid programs.”
“The Defense Criminal Investigation Service will continue to pursue unscrupulous companies focused on enriching themselves more than patient centric care and ethical conduct,” stated Special Agent in Charge Cynthia A. Bruce, DCIS, Southeast Field Office. “DCIS appreciates the U.S. Attorney’s Office efforts in this investigation and for requiring Ophthalmic Consultants to remunerate TRICARE for billing single dose medications to multiple patients.”
Thomas W. South, Deputy Assistant Inspector General for Investigations, OPM-OIG said, “I am very proud of the outstanding work from our investigators and law enforcement partners at the Department of Justice. When providers submit false claims, it undermines the healthcare system and increases costs for all taxpayers.”
As part of the settlement, Ophthalmic Consultants, P.A. and Dr. Robert K. Snyder entered into an Integrity Agreement (IA) with the Office of Inspector General (OIG), which promotes compliance with the statutes, regulations, program requirements, and written directives of Medicare and all other federal health care programs. The IA includes, among other things, routine inventory requirements as well as requirements focusing on proper billing and submission of reimbursement claims.
This settlement is the result of a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, the U.S. Department of Health and Human Services – Office of Inspector General, the Defense Criminal Investigative Service, and the Office of Personnel Management – Office of the Inspector General. Assistant U.S. Attorney Christopher Emden handled the case.
The United States government places a high priority on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800‑HHS‑TIPS (800-447-8477).