Consumer Fraud

Florida Eye Doctor Pays $1 Million To Settle Whistleblower Medicare Fraud Allegations

whistleblower Florida Eye Doctor Pays $1 Million To Settle Whistleblower Medicare Fraud AllegationsA Florida eye doctor has agreed to pay the U.S. government $1 million to settle a False Claims Act lawsuit brought by a whistleblower who accused her of fraudulently billing federal health care programs to support a lavish lifestyle.

Lori Moore, a former employee of Dr. Monique Barbour and her Clear Vue eye clinic in Lake Worth, Fla., told WPTV West Palm Beach said that after a number of years, she started becoming suspicious of the numbers.

Upcoding, bundling, billing for services that were never rendered. When you start running down how many patients she sees in a day … it just doesn’t add up,” Ms. Moore told WPTV.

According to her whistleblower complaint, Dr. Barbour billed excessively for patient visits at nursing facilities and assisted living facilities, routinely billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.

Records reviews showed that many of the procedures billed to Medicare and were medically unnecessary and provided little patient benefit, the complaint alleged. The records also revealed that Dr. Barbour billed procedures at the most profitable rates regardless of whether the procedures qualified for higher billing codes.

Additionally, billing and travel records showed Dr. Barbour had billed for procedures she purportedly performed at Clear Vue when she was out of the country.

Federal officials investigated Ms. Moore’s claims and opted to join her case.

Ms. Moore told WPTV that Dr. Barbour led a lifestyle that included multiple homes, vacations, and a double life as “Anayya Von Kitten,” an aspiring pop star.

“The Medicare program, a vital component of our health care system, is threatened when providers bill fraudulently or carelessly for their own financial interests,” U.S. Attorney Wifredo Ferrer said.

Shimon Richmond, a Health and Human Services Department special agent who investigated the case, indicated the doctor’s scheme to cheat Medicare was reckless.

“It is hard to imagine how a single practitioner believed billing for more hours than were possible to perform in a day would not alert law enforcement to a potentially fraudulent scheme,” he said. “Billing for work supposedly performed while you were physically in another country is a special kind of arrogance and disregard for the ethical care of patients.”

Ms. Moore, who worked in billings for Clear Vue, told WPTV that Dr. Barbour fired her when she learned she had filed the lawsuit. She will receive $200,000 of the $1 million recovery as a whistleblower award.

Sources:
WPTV West Palm Beach
The U.S.  Attorney’s Office, Southern District of Florida