Surgeon settles claim He was charged with falsely billing Medicare

January 06, 1993|By Patricia Meisol | Patricia Meisol,Staff Writer

The owner of a Silver Spring eye surgery center has agreed t pay $750,000 in restitution and penalties to settle federal charges he submitted false Medicare claims, the U.S. attorney for Maryland and the inspector general of the Department of Health and Human Services announced yesterday.

The case is the first in a stepped-up effort by the U.S. attorney to use civil action to supplement criminal cases in Medicare fraud and other frauds that help drive up health-care costs.

The settlement also represents one of the largest civil penalties in recent years in Maryland. The government collected $28.5 million nationwide last year in civil penalties involving Medicare. Criminal cases brought in another $40 million.

The payment by the ophthalmologist, Seymour J. Dubroff, is the result of a 1 1/2 -year investigation by Health and Human Services. He was accused of submitting to Medicare $180,000 in bills for eye surgery that in some cases was not performed and in others was not reimbursable under federal rules. Under the agreement, the federal agency will not try to bar him from participating in Medicare.

The country is looking at "the whole issue of health care, including different aspects of cost, not the least of which is this kind of fraud," said Richard D. Bennett, the U.S. attorney.

Under the False Claims Act, the government can collect triple damages and does not have to meet the standard of proof required in a criminal trial. The settlement calls for Dr. Dubroff to pay $750,000 by Feb. 28; the figure is calculated by tripling the amount he allegedly billed falsely and adding the fines.

Dr. Dubroff, owner of the Dubroff Eye Surgery Center, has billed Medicare about $1 million a year in the past four or five years, according to Assistant U.S. Attorney David I. Salem.

The government said it found fraud in 185 bills submitted on behalf of his patients between 1986 and 1990. The case began with a tip from one of Dr. Dubroff's patients who had received a statement from Medicare that showed excess payments. In some cases, Mr. Salem said, the doctor would charge five or six times for a patient who had two operations or procedures.

In other cases, he said, the doctor sought reimbursement for routine sutures not normally covered by describing them as a different, more complicated laser procedure that is covered.

Dr. Dubroff's attorney, Gil Lessenco, managing partner of the Washington office of Semmes, Bowen and Semmes, said the four-page settlement does not include an admission of liability on the part of Dr. Dubroff. He said the doctor settled because he was concerned he might not be able to submit Medicare claims during a trial, which could take years and cost $300,000 in legal fees. The lawyer also said Dr. Dubroff has hired a consultant to train employees in the federal government's new coded billing system to prevent future claims mistakes.

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