A South Dakota optometrist reached a settlement with the South Dakota Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU), and the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG). The optometrist will be shelling out $283,499 to resolve allegations he submitted false claims to Medicare, Medicaid and TRICARE, according to the South Dakota AG. This settlement was announced on October 1, 2013.
Optometrist Will Pay Fine and Sign Integrity Agreement as Part of the Settlement.
According to the AG, the optometrist allegedly submitted false claims to the health care programs for bifocal lenses, trifocal lenses and new patient visits. He is also accused of billing Medicare, Medicaid and TRICARE for medically unnecessary visual field examinations from June 2006 until December 2012.
On top of the fine, the optometrist will also sign an Integrity Agreement with the HHS, OIG. In the agreement, the optometrist will provide free eye care to underserved patients for one year, according to an article in Rapid City Journal.
Responding to a MFCU Investigative Subpoena.
This case against the optometrist was handled, in part, by the MFCU. The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. Click here to read practice tips on how to properly respond to a subpoena.
Fraud Charges Need to be Taken Seriously.
We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.
If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.
If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Be prepared to give up whatever you have if you can avoid a conviction.
Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.
Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.
South Dakota Attorney General. “Optometrist Settles Healthcare Case with South Dakota and United States.” South Dakota Attorney General. (October 1, 2013). From: http://atg.sd.gov/News/NewsReleases/NewsReleasesView/tabid/441/itemID/3251/moduleID/719/view/597/Default.aspx
Rapid City Journal Staff. “Optometrist Settles Case Involving Fraud Allegations.” Rapid City Journal. (October 1, 2013). From: http://rapidcityjournal.com/news/local/article_62eafa10-0c68-5240-aee5-97defb6627a5.html#.UkyGbJiR9mA.twitter
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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