On May 16, 2025, the United States Attorney’s Office for the Middle District of Florida announced that it had reached a False Claims Act (FCA) settlement with Florida-based ophthalmology practice Gulfcoast Eye Care. The government alleged that Gulfcoast violated the FCA by submitting false claims to Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds (TCDs). Under the terms of the settlement, Gulfcoast agreed to pay $615,000.
Specifically, the government alleged that Gulfcoast billed for TCDs performed on patients who did not have a qualifying diagnosis such as occlusion and stenosis of their cerebral arteries. The government also alleged that Gulfcoast violated the Anti-Kickback Statute (AKS) and the Stark Law by paying a third-party TCD provider based on the volume or value of tests ordered and referring the patients to the TCD provider’s preferred radiology group for the TCD’s professional component.
The case was the result of a lawsuit filed under the FCA’s qui tam (whistleblower) provisions, and the whistleblower will receive a little over $116,000 as part of the settlement.
This settlement reflects the government’s continued focus on FCA, AKS, and Stark Law enforcement against physician groups and other healthcare providers. Under the False Claims Act, a healthcare provider that submits a false or fraudulent claim or statement to a federal healthcare program can face significant monetary damages and penalties. Private whistleblowers — known by the FCA as “Relators” — are empowered to bring these allegations to the government’s attention and, in exchange, are entitled to a whistleblower award of between 15 and 30% of the government’s ultimate recovery.
The Anti-Kickback Statute (AKS) is a very broad statute which, in part, makes it a crime to knowingly and willfully pay or or receive anything of value in exchange for a federal healthcare program referral. Violations of the AKS can result in prison sentences of up to 10 years, plus significant civil and administrative remedies, up to and including exclusion.
The Stark Law — formally known as the Physician Self-Referral Law — provides that if a physician (or an immediate family member of the physician) has a financial relationship with an entity such as a hospital, that physician is prohibited from referring certain “designated health services” to that entity, and that entity is prohibited from submitting claims to Medicare or Medicaid for such services. Violations of the Stark Law can also result significant civil and administrative remedies, up to and including exclusion.
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The attorneys at Chilivis Grubman represent healthcare providers of all types and sizes in connection with False Claims Act investigations and litigation. If you need assistance with such a matter please contact us.