Retina Institute of California Medical Group and seven other defendants paid $6.65 million to settle allegations that they defrauded Medicare and Medicaid, though they did not admit liability, according to the Department of Justice.
Retina Institute, its former CEO, three of its physicians and three affiliated entities allegedly violated the False Claims Act by illegally billing Medicare and Medicaid/Medi-Cal between January 2006 and August 2017. Retina Institute has multiple locations throughout California.
Retina Institute and the other defendants were accused of:
- Misclassifying simpler exams as ones involving patients with severe or emergency conditions to obtain higher payments
- Waiving Medicare copayments and deductibles without proper documentation of patients' financial hardship
- Billing Medicare and Medicaid for services that weren't performed, necessary, documented or in compliance with rules and regulations
Four individuals were listed as defendants: Tom S. Chang, MD, Michael A. Samuel, MD, Michael J. Davis, MD, and Brett Braun, the former CEO of Retina Institute of California Medical Group.
The corporate entities named as defendants alongside Retina Institute were Tom S. Chang MD Inc., Pasadena-based California Eye and Ear Specialists, and San Gabriel (Calif.) Ambulatory Surgery Center. California Eye and Ear Specialists is a subsidiary of Trilogy Eye Medical Group where Drs. Chang and Samuel serve as senior executives.
The allegations were put forth in a whistleblower lawsuit filed by two former Retina Institute administrators, Bobbette A. Smith and Susan C. Rogers. They will receive a share of the settlement. The amount has yet to be determined.
The claims settled are only allegations; the defendants did not admit liability.
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