TITUS COUNTY, Texas (KETK) – The Arlington Ophthalmology Association P.L.L.C. also known as Kleiman Evangelista Eye Centers (K&E) with offices in East and North Texas agreed to pay a $2.9 million civil settlement.
They were accused of offering and paying kickbacks to optometrists to “induce referrals” of patients who qualified for cataract surgery, Eastern District of Texas U.S. Attorney Brit Featherston said on Thursday. This allegedly violated the False Claims Act and Anti-Kickback Statute.
The association is an ophthalmology provider group that has locations in Arlington, Dallas, Plano, Southlake, Mount Pleasant and Gun Barrel City.
“The Eastern District of Texas is committed to looking beyond labels and examining providers’ actual conduct. Although co-management can be a legitimate practice, merely applying that label does not give providers carte blanche to remunerate referring providers in order to secure business,” Featherston said. “We are committed to investigating any financial incentives offered to secure referrals, which cloud providers’ medical judgement, and violate the Anti-Kickback Statute.”
Korby Harshaw, the acting Special Agent in Charge with the Department of Health of Human Services, said kickbacks can cause risks for patients.
“Paying kickbacks to providers incentivizes doctors to treat patients based on illegitimate financial gain, rather than the patient’s needs and best interests,” Harshaw said.
According to Featherston, the Anti-Kickback Statute does not allow “offering, paying, soliciting, or receiving” money to request referrals for procedures that Medicaid, Medicare covers or other United States supported programs.
“The United States contends K&E provided remuneration to referring optometrists when it paid referring optometrists money untethered to actual non-Medicare and non-Medicaid covered services for referring cataract patients who received premium intraocular lenses (IOLs) or laser-assisted cataract surgery, guaranteed the automatic return of patients referred, provided optometrists free continuing education courses, rewarded top referring optometrists with expensive dinners, and invited referring optometrists, their family, and staff to Texas Rangers stadium games at the company suite. The fees paid to referring optometrists for patients who received premium lenses or laser-assisted cataract surgery were in addition to the reimbursement already received by the optometrists from Medicare and Medicaid for performing post-operative cataract care and were not tied to or commensurate with actual post-operative services specifically attributed to premium IOLs or laser-assisted cataract surgery rendered, and thus constituted unlawful remuneration under the Anti-Kickback Statute,” Featherston said.
This case is referring to allegations made against K&E and liability has not been established, officials said. In this settlement, K&E stated they will work with the Department of Justice, which is investigating others who possibly broke the law.
“This investigation originated from a civil lawsuit filed by a Relator, or whistleblower, under the qui tam provisions of the False Claims Act, which allows private parties to bring suit on behalf of the government for false claims and to share in any recovery. The whistleblower in this matter will receive a percentage of this civil settlement,” Featherston said.
To report fraud or abuse in the workplace, people can call the Department of Health and Human Services at 1-800-HHS-TIPS (800-447-8477).
“This civil settlement was the result of a coordinated effort between the U.S. Attorney’s Office, Eastern District of Texas, and the United States Department of Health and Human Services, Office of Inspector General. This matter was handled by Assistant U.S. Attorneys James Gillingham, Adrian Garcia, and Betty Young, Investigator Ann Williams, and Paralegal Christina Cate,” the U.S. Attorney’s Office said.