Be on the Lookout for Fraud by Eye Docs

At least it was better than a poke in the eye. Oh, wait – it really
was a poke in the eye. In April, a
Georgia doctor paid $790,000 to settle claims he cheated Medicaid by giving patients unnecessary eye
procedures – including puncturing their corneas.

Apparently healthcare whistleblowers and the lawyers who represent them
(like me) need to be watching for fraud by eye doctors billing Medicare
and Medicaid for
unnecessary treatments for their patients; it appears the Doraville, Georgia, doctor is not alone.
This month a Kentucky jury found a
Kentucky optometrist liable for giving elderly nursing home residents more than 11,085 unnecessary
eye examinations.

Georgia Doctor Accused of Billing for Unnecessary Eye Treatments

Georgia Attorney General Sam Olens went after Dr. Zheng Ziang Wang and
his clinic, the Wang Eye Clinic, P.C., for submitting Medicaid claims
for a number of unnecessary services such as inserting plugs in tear ducts
and photography of the inside of the eye. The AG said that Wang also overstated
just what he did, billing for more expensive procedures than he really
had performed. By far the most unnerving accusation, though, was that
Dr. Wang punctured his patient’s corneas for no medical reason,
and then billed Medicaid for it.

Yikes.

AG Olens’ office announced that Wang will be banned from Medicaid,
Medicare and all other government health-care programs (like Champus and
Tri-Care) for five years.

Kentucky Optometrist Liable for Unnecessary Exams for Elderly Patients

The Kentucky case involved allegations against Pulaski County doctor Philip
Robinson worked for Associates in Eye Care P.S.C. (“AEC”).
According to federal authorities – and a federal jury – Dr.
Robinson treated elderly patients in nursing homes to eye exams every
month, need it or not.

The Government sued AEC and Dr. Robinson under the False Claims Act. The
AEC optometry practice settled with the Government earlier this year, paying $800,000 to resolve the
accusations that it had unnecessarily billed Medicare and Medicaid.

Dr. Robinson decided to soldier on to a jury trial. This error in judgment
cost him $1,257,225. The jury concluded Dr. Robinson had given more than
11,000 unnecessary eye exams, which cost Medicare $419,075. Under the
FCA, Dr. Robinson is required to pay the government triple that amount.

At trial, the Government contended that Dr. Robinson had treated elderly
patients at twelve nursing homes in three Kentucky counties: Pulaski,
Lincoln and McCreary. The fraud, they alleged, went on from 2007 to 2012.
During that time, DOJ says the optometrist gave monthly eye exams to the
“vast majority” of his patients. Experts testified that “they
were unaware of any other optometrists that provided eye exams with this
frequency.”

Ominously for Dr. Robinson, the article about the jury verdict says that
the Department for Health and Human Services, Office of Inspector General
(HHS-OIG) is considering whether the doctor should be excluded from federal
health care programs, as Dr. Wang was.

With the exception of the puncturing of the corneas, which gives me chills,
it would be easy to look at this as sort of “low-grade” fraud.
So what’s the big deal? So some older people get frequent eye exams.
Eye exams aren’t really painful.

But the problem runs much deeper than a little wasted time. Medicare and
Medicaid wind up wasting their resources on medical care that isn’t
even important. And none of the federal healthcare programs has unlimited
funds – we as taxpayers only have so much money that we could conceivably
turn over to the Government.

But perhaps the most serious “side effect”, if you will, is
the distrust sown in patients’ minds. The healthcare system works
when patients believe their doctors are acting in the patients’
best interests. If patients come to distrust their doctors, the system
breaks down. Patients who do not trust their doctors’ recommendations
will not act on them. Patients who do not know whether to respect their
doctors’ advice will do one of two things: not even seek medical
advice, which is terrible for public health, or get second and third opinions
about every recommended procedure, which will decimate the available healthcare dollars.