The United States alleges that from September 2015 through December 2020, St. Michael’s Eye & Laser Institute (St. Michael’s) and Dr. Michaelos caused the submission of false claims for transcranial doppler (TCD) tests to Medicare and the Veterans Health Administration. A TCD test is a non-invasive diagnostic test that can be used to estimate the blood flow through certain blood vessels in the brain by bouncing high-frequency sound waves off blood cells. As part of the settlement agreement, St. Michael’s and Dr. Michaelos admitted to and accepted responsibility for facts underlying the settlement agreement. St. Michael’s had contractual agreements with an independent medical diagnostics company, Eyecuity, PLLC (Eyecuity). During the relevant time, Eyecuity paid St. Michael’s for referrals that St. Michael’s made for TCD tests, even though the parties’ contracts called for payment based on the cost of office space, staff, and utilities, and not per-patient or per-test that St. Michael’s referred to Eyecuity. When documenting the purported medical necessity of these tests, Eyecuity submitted claims to Medicare that indicated that patients had Vertebro-Basilar Syndrome or Vertebrobasilar Insufficiency (VBI), a very rare condition. But St. Michael’s physicians did not have reason to believe that patients had a diagnosis of VBI.
The United States contends that the claims for the TCD tests that St. Michael’s and Dr. Michaelos caused Eyecuity to submit to Medicare for...
The United States alleges that from September 2015 through December 2020, St. Michael’s Eye & Laser Institute (St. Michael’s) and Dr. Michaelos caused the submission of false claims for transc...