Bean Town Times

Burlington County Eye Physicians (BCEP), an ophthalmology practice with locations in New Jersey and Pennsylvania, and Dr. Gregory H. Scimeca, an ophthalmologist and the owner of BCEP, have agreed to pay $469,232 to resolve allegations that they submitted and caused the submission of false claims for payment for medically unnecessary transcranial doppler (TCD) tests to Medicare and the Federal Employee Health Benefit (FEHB) Program in violation of the False Claims Act.

A TCD test is a noninvasive diagnostic test used to estimate blood flow through certain blood vessels in the brain. Medicare and the FEHB Program reimburse healthcare providers for both performing the test and interpreting its results. However, a physician cannot bill for interpreting the test when they merely review another physician’s interpretation.

As part of the settlement agreement, BCEP and Dr. Scimeca admitted to and accepted responsibility for facts underlying the covered conduct. The United States alleges that from May 13, 2019 through February 22, 2021, BCEP submitted and caused the submission of false claims for TCD tests to Medicare and the FEHB Program. BCEP contracted with a medical diagnostics company (the “Company”) to perform TCD tests on BCEP patients. The Company staffed BCEP with a technician who reviewed patient files and filled out forms to order TCD tests for BCEP patients from the Company. BCEP physicians, including Dr. Scimeca, signed these order forms completed by the Company’s technician. At times, BCEP and Dr. Scimeca signed forms indicating that patients had diagnoses they did not have but would have supported the medical necessity of the test. Additionally, BCEP paid $30 either to the Company or a radiology company associated with it to interpret each TCD test while also billing Medicare and the FEHB Program for interpreting those tests.

The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare and other federally-funded programs. The statute aims to ensure that medical providers’ judgments are not compromised by improper financial incentives but are based on their patients' best interests.

The United States contends that claims for TCD tests submitted by BCEP and Dr. Scimeca were false because: (1) the TCD tests were medically unnecessary as patients did not have symptoms justifying them or they were not necessary for treatment; (2) BCEP and Dr. Scimeca billed for professional services they did not perform; and (3) their arrangement with the TCD company violated AKS because they accepted remuneration from it by billing for services provided by it.

“Health care practitioners must not bill for services they do not perform or bill for unnecessary procedures," said Acting United States Attorney Joshua S. Levy. "Full stop. When they do, they violate the law." He added that defendants also accepted unlawful kickbacks which often corrupt medical judgment resulting in unnecessary medical tests.

“When health care providers submit claims for services to the Medicare program, those services are expected to be medically necessary, actually performed, and free from illegal kickbacks,” said Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General.

The resolution includes claims brought under qui tam or whistleblower provisions of the False Claims Act where private parties can file actions on behalf of the United States and receive a portion of any recovery. As part of today’s resolution, approximately $84,460 will go to a whistleblower.

Acting U.S. Attorney Levy along with HHS-OIG SAC Coyne made this announcement today with valuable assistance provided by U.S Office of Personnel Management's Assistant U.S Attorneys Jessica J Weber & Christopher Morgan handling this matter.