San Diego Eye Doctors Pay $950,000 to Settle Medicare Billing Fraud Allegations

SAN DIEGO – Mark D. Smith and Fane Robinson, two San Diego-area physicians, have paid the United States $948,768.18 to resolve allegations that they violated the federal False Claims Act by knowingly submitting false claims to Medicare.

Dr. Smith and Dr. Robinson are medical doctors specializing in ophthalmology.  They maintain a medical practice in San Diego known as San Diego Retina Associates and are participating providers in federally-funded health care programs including Medicare.

The United States alleged that Drs. Smith and Robinson violated the False Claims Act by submitting false claims to Medicare for care that was provided by a San Diego Retina Associates physician who was not properly credentialed at the time to render care to Medicare patients. 

The United States also alleged that Drs. Smith and Robinson improperly received Medicare payments when another San Diego Retina Associates physician provided care to Medicare patients but Drs. Smith and Robinson submitted claims that misidentified the treating physician. 

The settlement concludes a lawsuit originally filed in the United States District Court for the Southern District of California by Atul Jain, M.D., an ophthalmologist and former partner at San Diego Retina Associates. Dr. Jain sued under the qui tam, or whistleblower, provisions of the False Claims Act, which permits a private citizen to initiate a lawsuit on behalf of the United States for false claims and to share in the recovery.  Dr. Jain will receive $170,778.27 of the proceeds from the United States’ settlement with Drs. Smith and Robinson. 

“Falsely billing in order to circumvent Medicare’s oversight of physicians negatively impacts taxpayers and puts at risk patients’ health,” said U.S. Attorney Robert Brewer. “This settlement reflects our commitment to maintain the integrity of the Medicare program. As this settlement also reflects, we continue to vigorously investigate cases brought to our attention by whistleblowers.  We commend the whistleblower in this case, Dr. Jain, for coming forward and for working with investigators.” 

“Federal health care beneficiaries can clearly see federal health programs’ need to pay only for the services of properly credentialed eye doctors and other medical professionals. To do otherwise could harm both patients and taxpayers,” said Timothy B. DeFrancesca, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “We will continue working closely with our law enforcement partners to protect government healthcare programs and enrolled beneficiaries.”   

The investigation was conducted by the U.S. Attorney’s Office for the Southern District of California and the U.S. Department of Health and Human Services’ Office of Inspector General.   This case is captioned United States, et al. ex rel. Jain v. Dr. Mark D. Smith, M.D., et al., Case No. 18-cv-1213-AJB (WVG), and the matter was handled by Assistant U.S. Attorney Joseph P. Price, Jr. of the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office. U.S. Attorney Brewer commended the prosecutors and investigators for working hard to bring the case to a successful conclusion.