On October 4, 2019, the DOJ announced a $6.65 million settlement with a Southern California ophthalmology group, its former CEO, and several physicians, to resolve False Claims Act (FCA) allegations related to fraudulent billing practices. Under the settlement terms, the defendants paid sums to both the United States and the State of California to settle the case without an admission of liability.

Two former administrators at the ophthalmology group of Retina Institute of California Medical Group (RIC) brought the whistle blower action alleging RIC and the other defendants attempted to boost referrals to the group by waiving Medicare co-payments and deductibles without proper documentation of patients’ financial hardship. According to the complaint, between January 2006 and August 2017 defendants also intentionally changed billing codes to misclassify exams to increase reimbursements and billed Medicare and Medicaid for services that were never performed, unnecessary, or in violation of applicable rules and regulations.

The former RIC employees who prosecuted the case on behalf of the government will receive an undisclosed portion of the settlement. The State of California, United States Attorney’s Office, and OIG all monitored the case.

The case was filed in May 2013 in the U.S. District Court for the Central District of California and is captioned United States, et al., ex rel. Smith and Rogers v. Tom S. Chang, M.D., et al., No. 2:13-cv-03772-DMG-MRW (C.D. Cal.). The DOJ announcement can be found here.