In the back half of July 2026, the Department of Justice brought at least four separate enforcement actions touching ophthalmology within about two weeks, and the cases point to three vulnerabilities baked into how ophthalmology practices generate revenue.
Drugmaker EyePoint Pharmaceuticals paid a $4.7 million kickback settlement over an ASC drug program.
The Department of Justice indicted Bruce DiDonato, founder of New Jersey-based Campus Eye Management, on fraud and kickback charges, while separately declining to prosecute Campus Eye itself under a new corporate enforcement policy.
Boston-based Ophthalmic Consultants of Boston agreed to a $3.9 million billing settlement over improperly billed office visits alongside intravitreal injections.
Two New York ophthalmology practices agreed to a $2.3 million settlement over unnecessary cranial ultrasound testing, the same scheme that led five Florida practices to pay nearly $6 million in January.
The underlying allegations point to three recurring vulnerabilities rather than one bad actor:
1. Medically unnecessary diagnostic testing. In the New Jersey case, prosecutors allege a healthcare leader billed Medicare for unnecessary or duplicative diagnostic eye tests, then paid kickbacks to ophthalmologists for the surgery referrals those tests helped generate, according to the indictment. In the New York case, two practices allegedly ran patients through transcranial doppler ultrasounds that had no documented connection to their diagnoses, in an arrangement where a third-party testing company was paid based on test volume in exchange for referring patients to its preferred radiology group, according to the settlement announcement. Five Florida ophthalmology practices paid nearly $6 million in January to resolve allegations describing the identical Doppler-ultrasound, third-party-vendor structure.
2. Referral-based kickbacks, which take different forms depending on who’s doing the referring. Ophthalmology runs on a chain of referral relationships. Optometrists routinely refer patients to ophthalmologists for cataract surgery under “comanagement” arrangements, which the American Academy of Ophthalmology has specifically flagged as anti-kickback risk when the arrangement is structured to reward referrals rather than patient care. General ophthalmologists, in turn, refer patients to retina specialists for conditions requiring intravitreal injections, such as wet macular degeneration, according to the AAO. Additionally, device and drug makers compete for a share of high-volume procedures like cataract surgery, which was seen in the Precision Lens and EyePoint cases.
3. Billing around the specialty’s own procedures. According to the AAO, Medicare generally pays a single bundled fee for an intravitreal injection, and an office visit billed on the same day is only separately payable if it’s a significant, clearly distinct, well-documented service.
That pattern has already produced enforcement. A California ophthalmology clinic repaid nearly $400,000 to Medicare after an audit by HHS’ Office of Inspector General found it routinely billed for services “not separately identifiable” from the injections, and OIG has said it intends to keep targeting noncompliant ophthalmology billing on this point, according to McGuireWoods’ summary of the audit. OIG also has an active review underway of Eylea and Lucentis claims specifically for improperly billed evaluation-and-management services.
Layered on top of all this is consolidation. Nearly 40% of ophthalmology physician-practice deals between 2017 and 2021 were private-equity-driven, and roughly 8% of ophthalmologists worked for PE-backed management-services organizations as of 2022, with deal activity picking back up through 2025 after a lull, according to Physician Growth Partners.
Campus Eye, the MSO at the center of the Mr. DiDonato indictment was itself built on that model, providing billing and management services to an affiliated optometry practice and ASC, per the Justice Department declination announcement. That combination — high per-claim testing and drug spend, multi-party referral chains and a growing layer of MSOs sitting between the physician and the billing decision — tracks with what analysts have identified as the structure that draws the closest scrutiny of PE-owned healthcare: arrangements where a management company controls billing and coding decisions, appoints practice leadership, or holds board seats, which Justice Department and OIG guidance treats as grounds for provider-level liability, according to a 2024 report from professional services firm Guidehouse.
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