Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Associates, Inc., and the Foundation of the Massachusetts Eye and Ear Infirmary, Inc. (collectively “Massachusetts Eye and Ear”) have agreed to pay $2.678 million to resolve allegations that they violated the False Claims Act. Massachusetts Eye and Ear provides inpatient and outpatient services to patients with a range of ailments involving the eye, ear, nose and throat. Over an eight-year period, Massachusetts Eye and Ear improperly billed federal healthcare programs for certain office visits, defrauding the United States of more than a million dollars. The United States contends that between Jan. 1, 2012 and Feb. 1, 2020, Massachusetts Eye and Ear regularly submitted claims to Medicare and MassHealth—Massachusetts’s Medicaid program—for office visits at which physicians performed certain medical procedures, specifically, nasal endoscopies and laryngoscopies. Medicare and MassHealth do not permit billing for such office visits in addition to billing for the procedures, except under special circumstances that were not present here. As a result of the illegal conduct, Massachusetts Eye and Ear obtained reimbursements to which it was not entitled.
