Eye Doctor Group, Physicians Pay $6.65 Million to Settle Allegations They Submitted Fraudulent Bills

Eye Doctor Group, Physicians Pay $6.65 Million to Settle Allegations They Submitted Fraudulent Bills to Medicare and Medicaid


LOS ANGELES – A Southern California-based ophthalmology group, its former CEO and several of its physicians have paid the United States and California $6.65 million to settle False Claims Act allegations that they defrauded public health care programs by billing for unnecessary eye exams, improperly waiving Medicare co-payments, and violating other regulations, the Justice Department announced today.

Retina Institute of California Medical Group (RIC), is a medical partnership of ophthalmologists who specialize in the treatment of retinal diseases. RIC operates in multiple locations in Los Angeles, Orange and Riverside counties. On October 2, the RIC and several other defendants paid the United States $6,353,410 and paid California $296,590 pursuant to a settlement agreement.

The other defendants who participated in the settlement are:

• Dr. Tom S. Chang, of Pasadena;
• Tom S. Chang, M.D., Inc., a Pasadena-based company;
• Dr. Michael A. Samuel, of Arcadia;
• Dr. Michael J. Davis, also of Arcadia;
• Brett Braun, former CEO of Retina Institute of California Medical Group;
• Eye and Ear Specialists, a Pasadena-based subsidiary of Trilogy Eye Medical Group Inc., a company for whom Chang and Samuel serve as senior executives; and
• San Gabriel Ambulatory Surgery Center LP, a San Gabriel-based company.

Between January 2006 and August 2017, the defendants allegedly violated the False Claims Act by submitting bogus claims to Medicare and Medicaid/Medi-Cal, according to a settlement agreement signed in this case. Medicare reimburses physicians for examining patients, paying more money as the medical exams performed increase in complexity. RIC personnel allegedly improperly billed public health programs by misclassifying simpler exams as being more complex, using billing codes normally used for patients with severe or emergency conditions.

Read more: https://www.justice.gov/usao-cdca/pr/eye-doctor-group-physicians-pay-665-million-settle-allegations-they-submitted