Monday, December 19, 2016

Eyeland Optical Centers Settles Civil False Medicaid Claims Case For Billing for More Than 4 Lenses Per Year and Not Self Reporting

On December 6, 2016, Eyeland Optical Centers, a chain of eye care centers in Pennsylvania settled allegations under the False Claims Act with the U.S. Attorney's Office.  

The settlement resolves allegations that Eyeland had billed Medicaid for more than four lenses per year, in violation of Pennsylvania’s Medicaid regulations, and retained those payments even once it became aware that it had done so. This type of billing happens when patients lose glasses or break them but there are limits on what state programs pay for in order to avoid abuse.

The self-reporting rules in the OIG's Civil Monetary Penalties (CMP) Law are beginning to be enforced more aggressively.  The CMP law requires that overpayments must be reported and returned within sixty days of the date that the overpayment was identified or that a related cost report was due (whichever is later). The default penalty for this type of violation is $10,000 per item or service. 

In addition, computerized or "big" data is being used to identify billing irregularities or violation of billing rules. This case shows how this failure to self-report was used as evidence in the false claims case and how easy it was for the government to use big data to identify billing for services not allowed. Eyeland has agreed to pay $135,328.56 to resolve these claims.  

Posted by Tracy Green, Esq.


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