A local optometrist is facing allegations that he submitted hundreds of fraudulent claims for Medicare and Medicaid payments over a six-year period.
Dr. Phillip Robinson and employer Associates in Eye Care P.S.C. — which has offices in seven cities in both south-central Kentucky and Tennessee, including Somerset (according to their website, www.seemuchbetter.com) — are listed as defendants in a complaint filed in U.S. District Court, Eastern District, by Kerry Harvey, a United States Attorney.
The complaint — dated May 13, 2013 — states that from January 2007 through January 2012, Robinson “provided, or claimed to provide eye examinations and other optometric services to Medicare and Kentucky Medicaid beneficiaries residing in nursing homes” in the eastern part of Kentucky. The lawsuit also states that Associates in Eye Care (AEC) submitted those claims for payment “for Robinson’s actual or alleged optometric services.”
The complaint alleges that “(i)rrespective of condition or diagnosis, Robinson provided eye examinations to most of his nursing home patients on a monthly basis, a frequency that was unreasonable and unnecessary given the patients’ medical conditions.”
Robinson is alleged to have performed an excessively high volume of exams to nursing home patients — more than 50 a day — and on at least 11 different occasions, 100 or more Medicare and Kentucky Medicaid patients in a single day, according to Harvey’s claims.
“To the extent they were actually performed, these eye examinations were so cursory that they failed to provide the level of service necessary to justify Robinson and AEC’s claims to Medicare and Kentucky Medicaid,” reads the complaint. “ ... These claims were false or fraudulent in that they requested payment for optometric services that were not medically reasonable or necessary, and/or claimed reimbursement for a level or type of optometric service that was not actually provided.”
Robinson was allegedly the optometrist at AEC that did this “with limited exception,” increasing his examinations in 2007. The complaint compares these numbers to those Robinson allegedly maintained the year before: in 2006, Robinson billed Medicare (via AEC) for 152 services moderate complexity (typically about 25 minutes long) and seven of low complexity (typically about 15 minutes, for $7,210.75 in reimbursements, part of a Medicare total for the year of over $9,574.