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Prominent eye doctor accused in $108M Medicare fraud scam

A high-profile criminal trial is under way involving an eye doctor who is accused of operating a $108 million Medicare fraud scam involving senior citizens and minorities.

At the opening of the trial, prosecutors for the federal government said that the Harvard- and Yale-educated ophthalmologist was diagnosing patients with macular degeneration, an age-related condition that causes blindness, even before they had been examined.

They said patients who did not have the condition went through numerous invasive procedures so that the doctor could rack up a “superbill” to submit to Medicare.

They said the doctor had patients submit to outdated eye tests to look for the condition and that he billed the federal government tens of thousands of dollars instead of using a “state-of-the-art” machine for testing, which would have resulted in just a $50 payment from Medicare.

But when it was time for the doctor’s attorney to address the jury, a different side of the story emerged. He said that the only thing his client was guilty of was honest billing mistakes, and that lawyers for the government were using the mistakes to create an inaccurate picture of what went on.

He pointed out that the government’s experts even disagreed when looking at patient files, saying that the field of medicine is often not black and white.

Still, with more than 70 criminal counts of fraud against him, the eye doctor faces an uphill battle, especially after this week, when Florida ophthalmologists who had worked with the doctor in the past were called to testify against him.

One ophthalmologist said hundreds of patients had trusted the accused doctor’s promise that if they stayed under his care they would not go blind. The local ophthalmologist seemed to think the patients were being taken advantage of. You can read more about the case here and here.

How to avoid Medicare fraud charges

Not all Medicare fraud charges involve high-profile trials or accusations of million-dollar fraud operations. Most instances of Medicare fraud allegations get little attention from the media or the public. But they can still ruin the careers of doctors and result in huge fines and criminal charges. This is true even if providers didn’t intend on defrauding the government.

For this reason, it’s extremely important for health care providers to work with a health care law attorney to make sure that their billing practices are in line with the law.