Eye Doctor Group Pays $6.65 Million to Settle Overbilling Claims

A Southern California ophthalmology group’s former CEO and several of its doctors paid $6.65 million to settle allegations involving Medicare overbilling, prosecutors announced Oct. 4.

Retina Institute of California Medical Group and the other defendants paid the U.S. $6,353,410 and California $296,590 earlier this month, resolving allegations that they submitted false claims to Medicare and Medicaid/Medi-Cal for more than a decade. The settlement stems from a False Claims Act lawsuit brought by two former employees for the eye group.

The physician group was accused of sending fraudulent bills for unnecessary eye exams, and improperly waiving Medicare co-payments “without proper documentation of patients’ financial hardship” to boost referrals, according to the DOJ.

“RIC personnel allegedly improperly billed public health programs by misclassifying simpler exams as being more complex, using billing codes normally used for patients with severe or emergency conditions,” government officials wrote in an announcement.

The scheme allegedly took place between January 2006 and August 2017. The whistleblower suit was brought by Bobbette A. Smith and Susan C. Rogers, two former RIC administrators who will receive an undetermined portion of the settlement funds.

Defendants who participated in the settlement include RIC, its former CEO Brett Braun, Drs. Tom S. Chang, Michael A. Samuel, Michael J. Davis, and other companies. The defendants didn’t admit liability under the settlement terms.

The case is United States of America et al v. Tom S Chang et al, C.D. Cal., No. 2:13-cv-03772-DMG-MRW, settlement announced 10/4/19.