Eye Consultants Pays $790K for Medicare Billing Violations Involving Eye Injections

Eye Consultants of Pennsylvania has agreed to pay $790,000 to settle allegations that it submitted improper Medicare claims over several years. According to a press release from the U.S. Attorney’s Office for the Middle District of Pennsylvania, the civil settlement resolves claims that the practice violated the False Claims Act by billing Medicare for services that were not eligible for reimbursement under federal guidelines.

Between September 1, 2018, and April 7, 2025, the practice allegedly billed Medicare Part B for Evaluation & Management (E&M) services on the same dates that patients received bilateral eye injections. This type of billing was inconsistent with Medicare rules, which generally do not permit separate E&M billing when such injections are the primary reason for the visit and no additional evaluation or management is performed.

The improper billing practice could have contributed to inflated healthcare costs, potentially affecting the long-term financial health of Medicare, a program funded by taxpayers. The case was investigated by the Department of Health and Human Services Office of Inspector General and prosecuted by the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office.

The settlement is part of a broader effort by federal authorities to crack down on healthcare fraud and ensure proper use of public funds. While Eye Consultants of Pennsylvania did not admit liability, the resolution reflects a growing emphasis on enforcement of Medicare billing rules across the healthcare sector.

Article by multiple contributors, based upon information from the U.S. Attorney’s Office for the Middle District of Pennsylvania press release.

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