San Diego Eye Doctors, Medicare Billing Fraud, California 2020
In a shocking turn of events, two San Diego-area physicians have paid a hefty sum to settle allegations that they submitted false claims to Medicare. Mark D. Smith and Fane Robinson, medical doctors specializing in ophthalmology, have paid the United States $948,768.18 to resolve the allegations.
The U.S. Attorney’s Office for the Southern District of California and the U.S. Department of Health and Human Services’ Office of Inspector General led the investigation, which was conducted under the qui tam provisions of the False Claims Act. Atul Jain, M.D., an ophthalmologist and former partner at San Diego Retina Associates, filed the original lawsuit.
The government alleged that Drs. Smith and Robinson submitted false claims to Medicare for care provided by a physician who was not properly credentialed at the time. Additionally, they allegedly misidentified the treating physician when another San Diego Retina Associates physician provided care to Medicare patients.
The settlement concludes a lawsuit filed in the United States District Court for the Southern District of California. Dr. Jain will receive $170,778.27 of the proceeds from the United States’ settlement with Drs. Smith and Robinson.
“Falsely billing in order to circumvent Medicare’s oversight of physicians negatively impacts taxpayers and puts at risk patients’ health,” said U.S. Attorney Robert Brewer. “This settlement reflects our commitment to maintain the integrity of the Medicare program.”
Defendant: Mark D. Smith and Fane Robinson
Crime: Violating the federal False Claims Act by knowingly submitting false claims to Medicare
City and State: San Diego, California
Exact Date: January 2, 2020
Sentence or Outcome: Paid $948,768.18 to settle allegations
The investigation was conducted by the U.S. Attorney’s Office for the Southern District of California and the U.S. Department of Health and Human Services’ Office of Inspector General. The case is captioned United States, et al. ex rel. Jain v. Dr. Mark D. Smith, M.D., et al., Case No. 18-cv-1213-AJB (WVG), and was handled by Assistant U.S. Attorney Joseph P. Price, Jr. of the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office.
Key Facts
- State: California
- Category: Healthcare Fraud
- Source: DOJ Press Release â†â€â€
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