Philadelphia Vision Center Defeats Medicare Fraud Claims

July 21, 2021, 1:16 PM

Philadelphia Vision Center and others avoided a False Claims Act whistleblower’s complaint because she didn’t adequately allege they defrauded federal healthcare programs by improperly billing for eye exams, a Pennsylvania district court said.

Alisha Alejandro said PVC submitted claims for Medicare and Medicaid reimbursement under certain doctors’ National Provider Identifier numbers even when care was provided by another doctor, and retained unlawful payments from false payment requests.

But Alejandro’s complaint didn’t satisfy the FCA materiality standard because it didn’t show that PVC’s claims wouldn’t have been paid if it used the correct NPI number as opposed to that of a ...

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