Five Florida ophthalmology practices agreed to pay nearly $6 million to resolve allegations that they submitted false claims to Medicare and Medicaid tied to trans-cranial doppler ultrasounds and an alleged kickback arrangement with a third-party testing company.
Five Florida eye practices — Clay Eye Holdings LLC, Retina Macula Specialist of Miami LLC, Florida Eye Institute P.A., Miami Eye LLC, and Kendall Eye Institute Inc. — reached civil settlements totaling nearly $6 million over claims tied to trans-cranial doppler ultrasounds, often abbreviated as TCDs. The government says the billing stemmed from an improper referral and payment scheme involving a third-party testing company that led to medically unnecessary tests. The alleged conduct is said to have occurred between Jan. 1, 2018 and June 1, 2022. The practices agreed to cooperate with continuing Justice Department investigations into other participants.
Authorities contend the settling practices performed TCDs on thousands of patients and billed Medicare and Medicaid hundreds of dollars per test. The complaint alleges that, before patients got actual results, the practices and the third-party testing company identified those patients as having a serious diagnosis that could qualify them for reimbursement. “Kickbacks and false claims increase healthcare costs for all Americans and undermine the integrity of healthcare decision-making,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division.
The United States alleged the tests were medically unnecessary and premised on false diagnoses, and that the referrals and payments violated the Anti-Kickback Statute and the Stark Law. Regulators also said nearly all patients who underwent the TCDs did not have the diagnosis purportedly justifying the tests, and that those diagnoses were not reflected in the patients’ medical histories or the TCD results. The government framed the settlements as part of a broader effort to protect federal healthcare dollars.
“These settlements are a continuing testament to the United States’ commitment to fight healthcare fraud and ensure that federal healthcare dollars are spent consistently with the law,” said U.S. Attorney Gregory W. Kehoe for the Middle District of Florida. The civil suits in this matter were brought under the qui tam provision of the False Claims Act, which allows private parties to sue on the government’s behalf and share in recoveries. As part of the resolution, the whistleblower who filed the qui tam suit will receive $1,135,250 from the settlements.
Investigators say the practices paid the third-party testing company based on the volume or value of tests ordered and referred patients to that company’s preferred radiology group for the TCDs’ professional component. “Submitting false claims destroys the public’s trust in our federally funded healthcare programs,” said Special Agent in Charge Matthew Fodor of the FBI Tampa Field Office. Authorities described the payment model as incentivizing unnecessary testing rather than objective clinical decision-making.
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” said Acting Special Agent in Charge Ricardo Carcas of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). The settlements resolve allegations that the practices knowingly submitted, or caused the submission of, false claims to Medicare and Medicaid for TCDs that were medically unnecessary and based on false diagnoses. The government emphasized interagency cooperation in investigating and prosecuting these schemes.
The settlement breakdown assigns specific amounts to each practice: Clay Eye Holdings LLC will pay $2,140,000, Retina Macula Specialist of Miami LLC will pay $1,750,000, Florida Eye Institute P.A. will pay $1,250,000, Miami Eye LLC will pay $525,000, and Kendall Eye Institute Inc. will pay $310,000. Of the total recovery, $333,500 will be paid to the State of Florida for its share of Medicaid, which is jointly funded by federal and state dollars. These sums reflect civil compromise rather than criminal adjudication.
The civil settlements were handled by the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Middle District of Florida, with assistance from HHS-OIG and the FBI. Trial Attorney Nelson Wagner in the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Mamie Wise for the Middle District of Florida handled the matter. The Justice Department noted it has previously resolved similar allegations with other ophthalmology practices in the region.
The government framed this enforcement action as part of an ongoing emphasis on combating healthcare fraud through tools like the False Claims Act, and encouraged reporting of suspected fraud, waste, and abuse. The settlements resolve civil claims alleging violations tied to unnecessary TCDs, false diagnoses, and statutory prohibitions intended to prevent financial conflicts in medical decision-making. The companies’ cooperation with ongoing investigations will be a factor in how the matter unfolds going forward.
