A Houston-based medical clinic and its owner are accused of billing Medicare for services not provided.
According to a lawsuit filed by the United States, Outreach Diagnostic Clinic and Outreach Eyecare knowingly charged for special eye pressure tests never performed on patients in order to receive reimbursement from Medicare.
The complaint alleges that the defendants performed standard eye pressure tests on Medicare patients during intermediate and comprehensive eye care services for which they received reimbursement from Medicare. Simultaneously, they allegedly charged Medicare for a special eye pressure test claiming it was performed separately on the same day as the eye care services.
However, the complaint alleges that Outreach Diagnostic and Outreach Eyecare never performed the special eye pressure test on Medicare patients. In fact, they did not even have the necessary equipment to perform the special eye pressure test, according to the allegations.
The original lawsuit was filed by Dr. Michael Sorensen under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the United States when they believe people are submitting false claims for government funds.
The private plaintiffs, called ‘relators,’ are entitled to receive a share of any recoveries in the lawsuit. The False Claims Act permits the government to recover three times its damages plus a civil penalty of $5,500 to $11,000 for each false claim.
Department of Health and Human Services – Office of Inspector General investigated and Assistant U.S. Attorney Jose ‘Joe’ Vela Jr. is handling the case.
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Key Facts
- State: Texas
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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