Burlington County Eye Physicians (BCEP), an eye care practice based in New Jersey and Pennsylvania, along with Dr. Gregory H. Scimeca, agreed to pay $469,232 to resolve accusations of submitting false claims for medically unnecessary tests to Medicare and the Federal Employee Health Benefit (FEHB) Program. The resolution includes claims that were brought under the qui tam or whistleblower provisions of the False Claims Act.

BCEP and Dr. Scimeca allegedly billed Medicare and the FEHB Program for transcranial doppler (TCD) tests that were medically unnecessary. How? TCD tests are used to check blood flow in the brain. Medicare and the FEHB Program pay for these tests if they are necessary for a patient’s treatment. However, BCEP was accused of ordering these tests for patients who didn’t need them, sometimes allegedly going so far as to fabricate patient diagnoses to justify the tests billed.

Dr. Scimeca and BCEP also allegedly billed for interpreting TCD test results that they did not personally review. They did this by paying another company to perform and interpret the tests, but then billed Medicare and FEHB as if BCEP had done the interpretation themselves.

The predominant allegation is that BCEP violated the Anti-Kickback Statute (“AKS”) which prohibits offering, paying, soliciting, or receiving remuneration to induce referrals or services covered by Medicare or Medicaid or other federal health programs. The purpose of the AKS is to ensure that medical professionals’ judgments and decision-making are not clouded by improper financial considerations and incentives that are not in the best interests of their patients. The arrangement between BCEP and the TCD company involved paying the company for test interpretations while also billing for those services, creating a financial incentive for unnecessary tests and billings.

“Health care practitioners must not bill for services they do not perform or bill for unnecessary procedures. Full stop. When they do, they violate the law. These defendants also accepted unlawful kickbacks, which all too often corrupt medical judgment and result in unnecessary medical tests,” said Acting United States Attorney Joshua S. Levy. “As this case demonstrates, our office is committed to investigating and holding accountable both the recipients of kickbacks and the companies paying them.”

BCEP and Dr. Scimeca allegedly manipulated billing practices for financial gain, compromising ethical medical care by prioritizing profits over patient needs. The settlement aims to address these violations and prevent similar abuses in the future.

If you have information about potential kickback violations or Healthcare Fraud more broadly, or would like to learn more about Whistleblower protection laws, you can speak to an experienced Constantine Cannon whistleblower lawyer team member. Please don’t hesitate to contact us for a free and confidential consultation.

Read Eye Doctor Accused of False Diagnoses, Double Billing, and Financial Incentives at constantinecannon.com