Knoxville, Tennessee – Southeastern Retina Associates, on 4th February 2020, paid 1.5 million U.S. dollars in settlement of False Claims Act in the U.S. District Court for the Tennessee Eastern District.
As part of the resolution, Southeastern Retina Associates signed a five-year Corporate Integrity Agreement with the United States Health and Human Services Department – Office of the Inspector General, calling for the implementation of an internal auditing process and risk evaluation in order to identify and resolve the changing compliance risks. The Corporate Integrity Agreement requires training, review, and monitoring to resolve the issue in the matter. The Southeastern Retina Associates has more than 250 workers in offices across the middle and eastern Tennessee, southwestern Virginia, and northern Georgia.
The resolution settles accusations that, between 2009 and 2016, the Southeastern Retina Associates inappropriately used Modifier 25 billing code to submit claims the Medicaid and Medicare for tests that were to be billed together with other procedures done on the same day. The resolution also settles accusations that in the same period, some billings to Medicaid and Medicare included higher examination charges than required.
The United States Attorney J. Douglas Overbey said that it is essential for health care providers to present accurate and rational prices for services that the taxpayers pay for. Overbey added that his office would remain committed to ensuring that government-funded healthcare programs are not overcharged.
Special Agent in Charge Joseph E. Carrico of the Federal Bureau of Investigation – Knoxville Division stated that health care fraud and misuse affects every American. The removal of valuable resources from the federal government programs resulting from exploitation leads to higher medical costs for everybody. Carrico added that the Federal Bureau of Investigation would keep working closely with local, state, and federal associates to investigate those who misuse government-funded health care systems.
Special Agent in Charge Derrick L. Jackson of the United States Department of Health and Human Services – Office of Inspector General in Atlanta said that they would continue to target physicians who engage in deceptive billings for more profits. Jackson added that such conspiracies cost government-funded health care systems millions of dollars and, in the process, befool taxpayers.
Special Agent in Charge Kim R. Lampkin of the Veterans Affairs Office of Inspector General – Mid-Atlantic Field Office said that the office is obliged to working with their law enforcement associates to find and investigate those who swindle or misuse Veterans Affairs’ health care programs. Lampkin’s further stated that the settlement of Southeastern Retina Associates’ matter shows that the Veterans Affairs Office of Inspector General will aggressively continue to investigate those who overbill Veterans Affairs systems that take care of the nation’s veterans.
Deputy Assistant Inspector General at the Office of the Inspector General Thomas W. South said that fraudulent claims to overbill government health care systems hinder the Federal Employees Health Benefits plan’s probity and increases the health care cost for everyone. South added that the settlement shows a united commitment to underseeing and charging those who engage in fraudulent billings that squander taxpayer money.
This investigation into Southeastern Retina Associates’ case was a combined effort of the Federal Bureau of Investigation – Knoxville Division, the Attorney General’s Office for Tennessee, the Office of United States Attorney for Tennessee’s Eastern District, the Department of Health and Human Services – Office of Inspector General, and the United States Personnel Management Office. The investigation was initiated by a suit filed in 2015 under the False Claims Act’s qui tam or “whistleblower” provisions, which allow private persons to sue on behalf of the attorney general for false claims and to share the recovery if any. The recovery share for the relator in this matter was 270,000 U.S. dollars.
The government was represented by the United States Assistant Attorneys Jeremy Dykes, Jessica Sievert, and Rob McConkey.
The submissions settled by the settlement agreement are merely allegations; there hasn’t been any liability determination.
You risk a severe imprisonment sentence and hefty fines if found guilty of breaching the False Claim Statute, Anti-Kickback Statute, or the Controlled Substance Act. Plotting to commit health care fraud by swindling state-sponsored programs such as TRICARE or Medicaid could also have you locked up in the big house as fast. Individuals accused of committing the above crimes are treated as lawbreakers, and they can face severe punishment when and if found guilty. When charged with any health care fraud-related offenses, seeking the services of an excellent and experienced legal team is a matter of when not if.
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