U.S. Attorney's Office

San Diego Eye Doctors Pay $950K to Settle Medicare Billing Fraud Allegations

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Two San Diego ophthalmologists have paid hundreds of thousands to the United States to settle allegations that they knowingly submitted false claims to Medicare, the U.S Attorney's Office announced on Jan. 2.

Mark D. Smith and Fane Robinson are medical doctors specializing in ophthalmology at San Diego Retina Associates, based in Linda Vista. Both doctors participate in federally-funded health care programs including Medicare, the U.S. Attorney's Office said.

Dr. Smith and Dr. Robinson were accused of violating the False Claims Act by submitting false claims to Medicare for care that was provided by a different physician at the medical office, who was not properly credentialed to give care to Medicare patients, according to the attorney's office.

The doctors were further accused of "improperly received Medicare payments," the attorney's office said, as another physician provided care to Medicare patients but they submitted claims misidentifying the treating physician.

The $948,748 payout settles a whistleblower lawsuit originally filed by Dr. Atul Jain, a former partner at the medical practice. Dr. Jain will receive about $170,000 of the proceeds from the settlement.

"Falsely billing in order to circumvent Medicare’s oversight of physicians negatively impacts taxpayers and puts at risk patients’ health," said U.S. Attorney Robert Brewer. "We commend the whistleblower in this case, Dr. Jain, for coming forward and for working with investigators."

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

The company website says both accused doctors serve on staff at several local hospitals.

NBC 7 contacted the medical office and have not yet received a response.

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