Eye Care Provider Convicted In $1.2M Medicare Scheme

JASPER, GA — A federal grand jury has convicted an eye care provider on 29 counts of fraud for filing false claims with Medicare and the Georgia Medicaid program for services never provided to patients, the U.S. Attorney's Office for the Northern District of Georgia said.

Matilda Lynn Prince was convicted Jan. 9 for filing claims for optometry and ophthalmology services that were never given to patients at two north Georgia practices.

“Prince stole hundreds of thousands of dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak. “Through our partnership with the Georgia Attorney General’s office, we will continue to fight the costly effects of healthcare fraud in this state that divert critical resources away from citizens who truly need these services.”

According to the U.S. attorney, Prince owned Pickens Eye Clinic in Jasper and operated Eye Gallery 20/20 in Calhoun. From September 2011 to February 2014, she submitted false claims to Medicare and Medicaid for eye care services that were never provided to patients.

Despite being previously excluded from both federal programs in September 2011 and informed of her ineligibility to be employed or involved with any entity that receives Medicare or Medicaid funds, the feds charge she operated under a new eye service company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered.

Prosecutors said Prince targeted her advertising towards senior citizens and disabled residents in housing complexes and community centers, offering on-site eye exams and prescription glasses at no charge to Medicare and Medicaid patients. She contracted with two licensed optometrists to provide basic eye exams, and these optometrists would sometimes travel with Prince to perform these exams.

Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures involving the surgical insertion of medical devices called punctal plugs into patients' tear ducts to treat dry eye conditions.

Prince also used identities of these two optometrists to bill Medicare and Medicaid repeatedly for this procedure, prosecutors added. On some occasions, she billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed. Prince fraudulently submitted over $1.2 million in insurance claims to Medicare and Medicaid for services never rendered.

Prince, 41, of Mineral Bluff, was convicted Jan. 9 after a jury trial on 29 counts of healthcare fraud. A sentencing date has not been set.

“The Medicaid Program is designed to provide benefits to some of the most vulnerable members of our community and depends on the integrity and honesty of those providers who bill Medicaid," said Georgia Attorney General Chris Carr. "When a provider bills Medicaid for services they did not provide, they victimize and take advantage of the people who need it the most. Our office will continue to work hand-in-hand with our federal and state partners to investigate these kinds of egregious cases."

This case was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General and the Georgia Medicaid Fraud Control Unit. Assistant U.S. Attorneys Bernita B. Malloy and Nekia S. Hackworth prosecuted the case.

Image via Shutterstock