Massachusetts Eye and Ear to Pay $2.6M to Resolve False Claims Act Allegations

April 22, 2021

Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates Inc. and the Foundation of the Massachusetts Eye and Ear Infirmary Inc., collectively referred to as Massachusetts Eye and Ear, have agreed to pay $2.678 million to resolve allegations that they violated the False Claims Act.

Massachusetts Eye and Ear provides inpatient and outpatient services to patients with a range of ailments involving the eye, ear, nose and throat. Over an eight-year period, Massachusetts Eye and Ear improperly billed federal health care programs for certain office visits, defrauding the U.S. of more than a million dollars.

“When health care providers submit improper claims to Medicare and Medicaid, they do two bad things: they unjustly enrich themselves, and they drain money needed for legitimate patient care,” said Acting United States Attorney Nathaniel R. Mendell in a press release issued by the U.S. Attorney’s Office for the District of Massachusetts. “This settlement punishes bad billing and helps safeguard government health care programs from fraud, waste and abuse.”

The U.S. contends that between January 1, 2012, and February 1, 2020, Massachusetts Eye and Ear regularly submitted claims to Medicare and MassHealth – Massachusetts’ Medicaid program – for office visits at which physicians performed certain medical procedures, specifically nasal endoscopies and laryngoscopies. Medicare and MassHealth do not permit billing for such office visits in addition to billing for the procedures, except under special circumstances that were not present in this case. As a result of the illegal conduct, Massachusetts Eye and Ear obtained reimbursements to which it was not entitled.

“Mass Eye and Ear received more than a million dollars from fraudulently billing federal healthcare programs over the course of eight years, undermining the integrity of our healthcare system, and increasing the financial burden on hard-working taxpayers,” said Joseph R. Bonavolonta, special agent in charge of the Federal Bureau of Investigation’s Boston Division, in the release. “We would like to thank the patient who had the courage to come forward with allegations of illegal conduct, and we’d like to encourage others to do the same because standing up for what’s right and safeguarding taxpayer dollars is critical, given that every year, the submission of false claims to the government costs taxpayers billions.”

The False Claims Act settlement resolves allegations originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties known as relators, to bring suit on behalf of the government and to share in any recovery. In connection with the announced settlement, the relator will receive 15% of the recovery.

Source: U.S. Attorney’s Office, District of Massachusetts

Topics Claims Massachusetts

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