2 ophthalmologists ordered to pay $170M for Medicare fraud

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Two Texas ophthalmologists must pay $170,553,350 in penalties for fraudulently billing Medicare, the U.S. Attorney’s Office for the Southern District of Texas said Nov. 18.

Mustapha Kibirige, MD, and Emelike Agomo, MD, operated the Outreach Diagnostic Clinic in Houston. A whistleblower complaint made by a former employee at the clinic alleged that between 2006 and 2012, the two physicians billed Medicare for glaucoma tests with an improper reimbursement code that resulted in higher reimbursements.

The U.S. sued the practice in 2015 in connection to the allegations.

The court found that the physicians submitted 14,450 false claims to Medicare. U.S. District Judge Lynn Hughes applied a $11,803 penalty to each false claim, resulting in the final amount the physicians must pay.

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