Massachusetts Ophthalmology Practice to Pay Nearly $4 Million to Resolve False Claims Act Allegations

BOSTON to Ophthalmic Consultants of Boston, Inc. (OCB) has agreed to pay $3,902,588.28 to resolve allegations that it falsely billed federal healthcare programs. Between Jan. 1, 2015 and July 30, 2025, OCB submitted claims to Medicare and MassHealth, Massachusetts’s Medicaid program, for office visits at which ophthalmologists administered intravitreal (i.e., directly into the eye) injections of certain medications. However, Medicare and MassHealth do not permit billing for office visits in addition to billing for the injections themselves, except under special circumstances. OCB billed for the office visits using a special billing code (Modifier 25) even when it did not perform the service to justify billing the extra amount or have documentation to support the extra billed amount. The government contends that, through this conduct, OCB submitted false claims to Medicare and MassHealth for these office visits. The settlement credits OCB for cooperation under the Department of Justice’s Guidelines for Taking Voluntary Disclosure, Cooperation, and Remediation into Account in False Claim Act Matters. The claims against OCB were brought under the whistleblower or qui tam provisions of the False Claims Act. Under the FCA, private parties may sue on behalf of the government for false claims for government funds and receive a share of any recovery. The relator will receive a share from the proceeds of the settlement. The lawsuit is captioned United States, et al., ex rel. John Doe v. Ophthalmic Consultants of Boston, Inc., et al., 24-cv-11495. U.S. Attorney Foley and Roberto Coviello, Special Agent in Charge, Health and Human Services-Office of Inspector General made the announcement today. The case is being handled by Assistant U.S. Attorney Steven Sharobem of the U.S. Attorney’s Office’s Affirmative Civil Enforcement Unit.

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