Physicians, medical group CEO pay $6.7M to settle billing fraud case in California

An ophthalmology group in California, its former CEO and several of its physicians paid the federal government and the state of California a combined $6.65 million to settle false claims allegations, according to the Department of Justice.

The CEO of Retina Institute of California Medical Group, which operates multiple offices across Southern California in Los Angeles, Orange and Riverside counties, and several of its physicians allegedly violated the False Claims Act by improperly billing Medicare and Medicaid. Between January 2006 and August 2017, the medical group allegedly used billing codes that are normally used for severe or emergency conditions for simpler exams, according to the Justice Department.

The defendants also allegedly waived co-payments and deductibles for certain patients without proper documentation of financial hardship and billed Medicare and Medicaid for medical services that weren't performed, were unnecessary or not documented in the medical record.

A former employee of the medical group originally brought the allegations under the qui tam, or whistleblower, provisions of the False Claims Act.

To resolve the allegations, the defendants paid the federal government $6.35 million and paid California $296,590.

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