SHERMAN – Ophthalmology provider group, Arlington Ophthalmology Association, P.L.L.C. d/b/a Kleiman Evangelista Eye Centers (“K&E”), with offices located in Arlington, Dallas, Plano, Southlake, Mount Pleasant, and Gun Barrel City, Texas, has agreed to pay $2,902,505 to resolve False Claims Act allegations that it offered and paid kickbacks to optometrists to induce referrals of patients who were candidates for cataract surgery in in violation of the False Claims Act and Anti-Kickback Statute, announced Eastern District of Texas U.S. Attorney Brit Featherston.
“The Eastern District of Texas is committed to looking beyond labels and examining providers’ actual conduct. Although co-management can be a legitimate practice, merely applying that label does not give providers carte blanche to remunerate referring providers in order to secure business,” said U.S. Attorney Brit Featherston. “We are committed to investigating any financial incentives offered to secure referrals, which cloud providers’ medical judgement, and violate the Anti-Kickback Statute.”
“Paying kickbacks to providers incentivizes doctors to treat patients based on illegitimate financial gain, rather than the patient’s needs and best interests,” said Korby Harshaw, acting Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG will not tolerate kickback arrangements, which undermine medical responsibility, put patients at risk, and can waste taxpayer dollars.”
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.
K&E routinely engaged in the practice of co-management of cataract surgery patients with optometrists who referred patients to K&E. Patients who undergo cataract surgery require post-operative monitoring and care. When post-operative care is rendered by another provider other than the surgeon, such as an optometrist outside the surgeon’s practice, this practice is generally referred to as co-management.
The settlement announced today resolves certain allegations that K&E’s remunerative arrangement with referring optometrists who co-managed patient care with K&E violated the Anti-Kickback Statute. The United States contends K&E provided remuneration to referring optometrists when it paid referring optometrists money untethered to actual non-Medicare and non-Medicaid covered services for referring cataract patients who received premium intraocular lenses (IOLs) or laser-assisted cataract surgery, guaranteed the automatic return of patients referred, provided optometrists free continuing education courses, rewarded top referring optometrists with expensive dinners, and invited referring optometrists, their family, and staff to Texas Rangers stadium games at the company suite. The fees paid to referring optometrists for patients who received premium lenses or laser-assisted cataract surgery were in addition to the reimbursement already received by the optometrists from Medicare and Medicaid for performing post-operative cataract care and were not tied to or commensurate with actual post-operative services specifically attributed to premium IOLs or laser-assisted cataract surgery rendered, and thus constituted unlawful remuneration under the Anti-Kickback Statute.
As part of the settlement, K&E has agreed to cooperate with the Department of Justice’s investigations of and litigation against other parties involved in the alleged violations of law.
This investigation originated from a civil lawsuit filed by a Relator, or whistleblower, under the qui tam provisions of the False Claims Act, which allows private parties to bring suit on behalf of the government for false claims and to share in any recovery. The whistleblower in this matter will receive a percentage of this civil settlement.
The government’s pursuit of these matters illustrates the government’s emphasis 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 1-800-HHS-TIPS (800-447-8477).
This civil settlement was the result of a coordinated effort between the U.S. Attorney’s Office, Eastern District of Texas, and the United States Department of Health and Human Services, Office of Inspector General. This matter was handled by Assistant U.S. Attorneys James Gillingham, Adrian Garcia, and Betty Young, Investigator Ann Williams, and Paralegal Christina Cate.
The claims resolved by this settlement is allegations only, and there has been no determination of liability.