On November 1, the U.S. Attorney’s Office for the Western District of Texas announced that a Texas-based optometrist agreed to pay the United States and the State of Texas $1 million to resolve allegations of violating the False Claims Act by submitting fraudulent claims to federal healthcare programs.
The doctor operated a network of optometry practices in Central Texas and according to the government, these practices “submitted claims to TRICARE, Medicare, and Medicaid using the National Provider Identifiers (NPIs) of optometrists who did not perform the services billed.” They allegedly did so “in circumstances where the optometrist who rendered services was not credentialed or enrolled in the Federal healthcare program billed.”
“Providers who submit inaccurate billing information threaten the integrity of program funds,” said U.S. Attorney Jaime Esparza of the Western District of Texas. “We will continue to work with our law enforcement partners to ensure that providers do not circumvent rules meant to ensure patients appropriate, quality services from physicians who are actually approved to participate in Federal healthcare programs.”
“The Defense Criminal Investigative Service (DCIS), the law enforcement arm of the DoD Office of Inspector General, is steadfastly committed to protecting the integrity of the TRICARE Program, which is vital to the health and well-being of our warfighters, retirees, and their families,” said Acting Special Agent in Charge Ryan Settle of DCIS’s Southwest Field Office. “DCIS and our prosecutorial partners will tirelessly pursue and prosecute individuals who seek to enrich themselves by jeopardizing the healthcare of TRICARE beneficiaries and defrauding American taxpayers.”
The settlement stemmed from a qui tam whistleblower suit filed against the doctor. Under the False Claims Act’s qui tam provisions, individuals may file lawsuits alleging government contracting fraud on behalf of the United States. In successful qui tam cases, whistleblowers are eligible to receive between 15 and 30% of the settlement.
In this case, the whistleblower’s share of the settlement have not yet been determined.
In July 2023, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
National Whistleblower Center (NWC) has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act
