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Feds get involved with Nashville ophthalmology group false billing case

The federal government is involved with a case against Nashville, Tenn.-based SouthEast Eye Specialists, which is accused of defrauding Medicare of "tens of millions of dollars," The Nashville Post reports.

What you should know:

1. Former state Rep. Gary Odom and several affiliates filed a suit against the practice in 2017, alleging kickbacks and improper fee-splitting that defrauded Medicare of several million dollars. The U.S. and state attorney's offices originally declined to intervene in August 2018, but the U.S. Attorney recently reversed course and joined the investigation.

2. According to the original complaint, SouthEast Eye Specialists allegedly paid kickbacks to optometrists to refer patients to the practice for surgery. They did this through co-management agreements where the ophthalmologist performing the surgery would receive 80 percent of the Medicare fee and the referring optometrist would receive 20 percent of the fee.

While co-management agreements are common in the field, the practice and its physicians allegedly abused them for financial gain.

3. Federal prosecutors have not yet filed their complaint, but did make a motion to add the practice's co-founders to the lawsuit.

4. SouthEast Eye Specialists is backed by Flexpoint Ford, a private equity firm. With the support of Flexpoint, the practice set up a patient referral program with the Center for Facial Rejuvenation in Chattanooga, Tenn. This referral program is not under question.

5. SouthEast Eye operates two surgery centers and 19 Tennessee locations.

Update: SouthEast Eye Specialists issued a statement on the case:

SouthEast Eye Specialists is deeply committed to providing the highest quality clinical care possible to those we serve. We provide management services to a group of thriving, well-respected physician practices and surgery centers, and hold ourselves to the very highest legal, ethical and compliance standards.

Just as we have from the beginning of this lawsuit, which began nearly three years ago, we believe our business practices are in full compliance with the law, that these allegations are without merit, and we will continue to defend vigorously our model of care, as well as the critical role optometrists play in patient care.

In no way does this complaint question the quality of patient care offered by our dedicated physicians, skilled clinicians and talented employees. We are tremendously proud of our team and intently focused on what’s most important: providing the best care and experience possible to those we serve.

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