May 25, 2023 - SouthEast Eye Specialists, SouthEast Eye Surgery Center, and the Eye Surgery Center of Chattanooga (SEES) must pay $17 million to the United States and Tennessee to resolve allegations that they violated the Anti-Kickback Statute and the False Claims Act.
Two whistleblowers alleged that SEES induced optometrists to refer patients to SEES for cataract surgeries by offering them several forms of financial remuneration. The referrals provided to SEES were reimbursed by Medicare and TennCare—Tennessee’s state Medicaid program—resulting in alleged violations of the False Claims Act.
The complaint was filed in Tennessee in 2017 by Ross Lumpkin, OD, an optometrist, and Gary Odom, a former executive in the statewide optometric association.
The lawsuit alleges that SEES used various approaches to incentivize the optometrists to initiate referrals, including continuing education, meals, sporting events, and inappropriate pre-arranged co-management agreements.
When cataract surgery is co-managed, the performing surgeon receives 80 percent of the Medicare reimbursement and the referring optometrist performing the post-operative exam receives 20 percent. Co-management should be decided on a case-by-case basis and consider patient health, convenience, and choice.
The whistleblower complaint states that SEES used this arrangement to serve its own interests and the interests of its referring optometrists instead of thinking of what was best for patients....
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