Legal Services For Optometry Clinics
Ophthalmologist, optometrists, and opticians are finding themselves wrapped up in more litigation recently as the Justice Department cracks down on health care fraud in the U.S.Government agencies are launching investigations into eye and vision care professionals who commit insurance fraud and Medicaid fraud by filing false claims, providing unnecessary treatments and “double billing” health care, vision care, and insurance providers.
We understand the health care industry and will provide you with the assistance and guidance you need during an investigation into your practice.Charges and accusations of health care fraud can lead to every inch of your business being scrutinized, and all of your personal, business, and finance records audited. Investigations can be undertaken by both federal and state agencies, so it is important to have an experienced team of attorneys who have handled cases in both jurisdictions.
What is “Optometry Fraud"?
“Optometry fraud” is basically a form of health care fraud. Generally, optometry fraud involves the filing of false or fraudulent claims with health care, vision care, or insurance providers. Allegations of optometry fraud usually stem from billing Medicare or Medicaid programs for medically unnecessary services. They also stem from submitting false or inflated claims for vision care and health care services and falsifying patient’s medical records.
In most cases, claims for eye and vision care treatments and benefits are improper and illegal if:
- The treatment was not medically necessary;
- The treatment was not medically reasonable;
- The patient was billed for services that were not actually provided;
- The patient was billed for a higher level of service than their condition required;
- The ophthalmologist, optometrist, or optician billed the wrong provider;
- The ophthalmologist, optometrist, or optician billed multiple providers; or if
- The ophthalmologist, optometrist, or optician alters the patient’s paperwork in order to create a fraudulent reason to justify services rendered.
What is “Double Billing”?
What Makes Filing A “False Claim” Illegal?
The False Claims Act (“FCA”) makes it illegal for optometry professionals to knowingly make a false statement on a claim submitted to a public or private health care providers. This includes a false statement in connection with all services rendered, including treatments, fittings, or products sold to patients.
Ophthalmologist, optometrists, and opticians who are found in violation of this statute will be charged with a felony and will be subject to a $250,000 fine, five years imprisonment, or both, for each false claim made.
Can I Be Charged for “Health Care Fraud?”
Ophthalmologist, optometrists, and opticians who violate this statute may face fines of up to $250,000, or imprisonment for up to 10 years.
How Are These Penalties Determined?
Who Investigates Charges of Health Care Fraud?
- The Office of the Inspector General (“OIG”);
- The U.S. Department of Health and Human Services (“HHS”);
- The Department of Justice (“DOJ”) Health Care Fraud Unit;
- The Federal Bureau of Investigations (“FBI”) Health Care Fraud Unit;
- The National Insurance Crime Bureau (“NICB”);
- The Coalition Against Insurance Fraud (“CAIF”);
- The National Association of Insurance Commissioners (“NAIC”)
- In 2007, the U.S. Department of Health and Human Services Office of the Inspector General (“HHS-OIG”) created a Medicare Fraud Strike Force to combat health care fraud;
- In 2009, the Attorney General and the Secretary of Health and Human Services also launched the Health Care Fraud Prevention and Enforcement Action (“HEAT”) initiative to combat health care fraud; and
- Most state Attorneys General Offices have a Medicaid Fraud Control Unit (“MFCU”).
What Should I Do if I Received a Letter Requesting Patient Records?
If you have received a letter from your health care, vision care or insurance provider requesting patient records or informing you that they will no longer be providing services to you or your business, there may be a reason to be concerned.
Requests for patient records from health care, vision care, or insurance providers may mean that the provider is initiating an investigation into your business. These types of audits can involve extensive document production, a loss of the provider’s services, and can often be the catalyst which leads to the state and federal investigations.
If you have received a letter from your health care, vision care, or insurance provider, and you are concerned about a potential investigation into your practice, you should contact an attorney immediately.
Our attorneys have experience with private investigations initiated by insurance providers, as well as experience with federal, state, and local investigations of insurance fraud, health care fraud, and Medicare fraud.