Massachusetts Ophthalmology Practice to Pay Nearly $4 Million to Resolve False Claims Act Allegations

Massachusetts Ophthalmology Practice to Pay Nearly $4 Million to Resolve False Claims Act Allegations

BOSTON - Ophthalmic Consultants of Boston, Inc. (OCB) has agreed to pay $3,902,588.28 to resolve allegations that it falsely billed federal healthcare programs. Between Jan. 1, 2015 and July 30, 2025, OCB submitted claims to Medicare and MassHealth-Massachusetts's Medicaid program-for office visits at which ophthalmologists administered intravitreal (i.e., directly into the eye) injections of certain medications. However, Medicare and MassHealth do not permit billing for office visits in addition to billing for the injections themselves, except under special circumstances. OCB billed for the office visits using a special billing code (Modifier 25) even when it did not have documentation to support the extra billed amount. The government contends that, through this conduct, OCB submitted false claims to Medicare and MassHealth for these office visits.

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