San Diego eye doctors pay $950,000 to settle Medicare billing fraud allegations – NBC 7 San Diego

Two San Diego eye doctors have paid hundreds of thousands of dollars to the United States to settle allegations that they knowingly submitted false claims to Medicare, the U.S. Attorney’s Office announced on January 2.

Mark D. Smith and Fane Robinson are ophthalmology physicians with Linda Vista-based San Diego Retina Associates. Both doctors participate in federally funded health care programs, including Medicare, the U.S. attorney’s office said.

Dr. Smith and Dr. Robinson were charged with violating the False Claims Act by submitting false claims to Medicare for care provided by another physician in the medical office, who was not properly licensed to provide patient care of Medicare, according to the attorney’s office.

The doctors were further charged with “improperly receiving Medicare payments,” the prosecutor’s office said, because another doctor provided care for Medicare patients, but they submitted claims identifying to wrong the attending physician.

The $948,748 payment settles a whistleblower lawsuit originally brought by Dr. Atul Jain, a former partner in the medical practice. Dr. Jain will receive approximately $170,000 of the settlement proceeds.

“False billing to circumvent Medicare oversight of physicians negatively impacts taxpayers and puts patient health at risk,” U.S. Attorney Robert Brewer said. “We commend the whistleblower in this case, Dr Jain, for coming forward and working with the investigators.”

The investigation was led by the U.S. Attorney’s Office for the Southern District of California and the Office of the Inspector General for the U.S. Department of Health and Human Services.

The company’s website says the two accused doctors are on staff at several local hospitals.

NBC 7 has contacted the doctor’s office and has yet to hear back.