On May 20th, the Department of Justice announced that Gulfcoast Eye Care, an ophthalmology practice, has agreed to pay $615,000 to resolve whistleblower allegations of violations of the False Claims Act. According to the Department of Justice, the whistleblower’s information not only stopped alleged ongoing criminal activity but also led to Gulfcoast Eye to cooperating with the DOJ’s ongoing investigation of other participants in the alleged scheme.
This case stems from a qui tam suit filed by a whistleblower who is set to receive approximately $116,850 of the settlement.
According to the Department of Justice, Gulfcoast Eye is alleged to have committed “kickback fraud” by performing medically unnecessary TCDs or “trans-cranial doppler ultrasounds.” These TCDs cost hundreds of dollars per test and were then reimbursed by Medicare and Medicaid if the patient was diagnosed with serious eye conditions like occlusion and stenosis of cerebral arteries. Gulfcoast Eye allegedly falsified diagnoses of occlusion and stenosis of cerebral arteries for that reimbursement while paying a third-party TCD provider based on the volume or value of TCD tests ordered. The government contends that these alleged actions violated the Anti-Kickback Statute and the Stark Law.
“Kickback arrangements can corrupt legitimate medical decision-making and undermine the integrity of federal healthcare programs,” said Acting Special Agent in Charge Ryan P. Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) reported to the Department of Justice. “HHS-OIG, working with our law enforcement partners, will continue to investigate improper billing and kickback schemes to protect both Medicare and Medicaid as well as those served by these programs.”
The False Claims Act qui tam provisions enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. In successful qui tam suits, whistleblowers are entitled to 15-30% of the funds collected by the government.
During FY 2024, settlements and judgments under the False Claims Act exceeded $2.9 billion and over $2.4 billion of the recoveries stemmed from qui tam whistleblower lawsuits. Furthermore, according to the government, a record 979 qui tam lawsuits were filed in FY 2024.
However, in September 2024, a district judge in Florida ruled that the False Claims Act’s qui tam provisions were unconstitutional. The U.S. federal government is urging the U.S. Court of Appeals for the Eleventh Circuit to reverse that decision, stating in a brief that “other than the district court here, every court to have addressed the constitutionality of the False Claims Act’s qui tam provisions has upheld them.”
National Whistleblower Center has issued an Action Alert allowing whistleblower supporters to write the members of Congress urging them to protect and strengthen and protect the False Claims Act.
The claims asserted in this case are allegations only, and there has been no determination of liability.
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