April 27, 2023. The Department of Justice settled a qui tam lawsuit that two whistleblowers filed against Dr. Paul Koch and the chain of ophthalmology practices he owned. The lawsuit alleged that Dr. Koch and his practices engaged in healthcare fraud by using financial kickbacks and sham co-management agreements to induce referrals of patients receiving cataract surgeries. The patients referred to the practice included Medicare beneficiaries, which means the claims for their surgeries were tainted by kickbacks. Two whistleblowers came forward and filed a qui tam lawsuit against the ophthalmologist and his eye care practices. The whistleblowers were awarded 22% of the $1,166,072 settlement or $256,535.84.
In this case, the two whistleblowers filed a qui tam lawsuit against Dr. Paul Koch, Claris Vision, and other eye car practices owned by Dr. Koch alleging that they engaged in fraudulent practices. According to the settlement agreement, Dr. Koch and his co-conspirators paid financial kickbacks to optometrists who referred patients to them for laser-assisted cataract surgery, which is an expensive cataract procedure. Patients who opted for this procedure paid up to $2,900 out-of-pocket per eye. The lawsuit further alleged that Dr. Koch entered into sham co-management agreements with optometrists. This practice is also illegal under the Stark Law, which prohibits doctors from making financial arrangements with referral sources. The Stark Law aims to ensure that medical decisions are made in the best interest of patients and not influenced by financial gain. The United States argued that these actions constituted illegal kickbacks under the Anti-Kickback Statute and resulted in the submission of false claims to Medicare under the False Claims Act.
Qui tam is a provision in the False Claims Act that allows private individuals to file lawsuits on behalf of the government for fraud committed against government programs. If successful, the individual who filed the lawsuit, called the relator, will receive a portion of the damages awarded to the government. The qui tam lawsuit against this ophthalmologist and his practice groups highlights the importance of staying compliant with healthcare laws and regulations. The allegations of fraud and illegal kickbacks can have severe consequences for healthcare providers, including hefty fines and exclusion from government programs. Navigating the legal landscape of qui tam lawsuits requires experienced legal representation, and the whistleblower attorneys at Tycko & Zavareei LLP can help.
If you would like to report Medicare fraud, you can contact attorneys at Tycko & Zavareei LLP. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renée now represent whistleblowers. For a free consultation, you can contact Eva Gunasekera at [email protected] or contact Renée at [email protected] (tel.: 202-417-3664). Visit Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.