Southeastern Retina Associates (“SERA”) has paid $1.5 million to resolve False Claims Act allegations in the United States District Court for the Eastern District of Tennessee. As part of the settlement, SERA entered into a five-year Corporate Integrity Agreement (CIA) with the US Department of Health and Human Services, Office of the Inspector General (HHS-OIG), requiring the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The CIA requires training, auditing and monitoring designed to address the conduct at issue in the case. Southeastern Retina Associates has over 250 employees in offices throughout eastern and middle Tennessee, northern Georgia, and southwestern Virginia. The settlement resolves allegations that, from 2009 through 2016, the practice improperly used the Modifier 25 billing code to charge Medicare and Medicaid for exams that were not separately billable from other procedures performed on the same day. The settlement also resolves allegations that certain Medicare and Medicaid billings during the same period included charges for exams at higher levels than appropriate.
