Local eye doctors pay $950K to settle billing fraud case

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SAN DIEGO — Two San Diego eye doctors have paid nearly $950,000 to resolve allegations that they submitted false claims to Medicare for treatment provided by a physician who was not properly credentialed, the U.S. Attorney’s Office said Thursday.

Mark D. Smith and Fane Robinson of San Diego Retina Associates violated the False Claims Act by submitting claims misidentifying which physician was treating patients, federal prosecutors said. The U.S. Attorney’s Office said the actual treating physician was not properly credentialed at the time to treat Medicare patients.

The settlement ends a lawsuit filed last year by ophthalmologist and former San Diego Retina Associates partner Atul Jain, who will receive around $170,000 of the proceeds, prosecutors said. Jain filed the lawsuit under the whistleblower provision of the False Claims Act, according to the U.S. Attorney’s Office.

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

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