Gulfcoast Eye Care agrees to pay $615000 after being accused of billing Medicare for unnecessary brain scans in Florida clinics

In a healthcare landscape where trust is everything, a Florida-based eye care provider has come under scrutiny for allegedly putting profits over patients.

Gulfcoast Eye Care, an ophthalmology practice with locations in Pinellas Park, Palm Harbor, and St. Petersburg, has agreed to pay a hefty $615,000 to resolve allegations of billing fraud involving Medicare and Medicaid.

Unnecessary Tests and Suspicious Diagnoses Raise Red Flags

At the heart of the case are transcranial doppler ultrasounds (TCDs)—a type of brain scan used to detect blood flow issues.

According to federal prosecutors, Gulfcoast Eye partnered with an outside provider to administer these tests to thousands of patients, then billed hundreds of dollars per procedure to federal programs.

But here’s the catch: many of these tests weren’t necessary in the first place.

Before results were even returned, patients were labeled with serious-sounding diagnoses—typically cerebral artery blockages—that would justify insurance reimbursement.

In reality, most patients never had these conditions, and their medical records didn’t support the diagnosis.

Alleged Kickbacks Add to the Legal Trouble

The situation worsened with allegations that Gulfcoast Eye was involved in a kickback scheme.

The clinic reportedly paid the third-party TCD provider based on how many tests were ordered and referred patients to a specific radiology group tied to the provider.

That type of payment arrangement violates both the Anti-Kickback Statute and the Stark Law, which are designed to prevent financial incentives from influencing medical decisions.

Medicare and Medicaid Took the Hit

Federal and state prosecutors say that this arrangement led to numerous false claims being submitted to Medicare and Medicaid—claims for tests that patients didn’t actually need, based on diagnoses that weren’t real.

Out of the total $615,000 settlement, $602,046 is earmarked for the U.S. government, while $12,953 will go to the State of Florida to account for Medicaid’s share.

U.S. Officials Speak Out Against Greed in Healthcare

“This kind of scheme undermines patient trust and damages the integrity of our healthcare system,” said Gregory W. Kehoe, U.S. Attorney for the Middle District of Florida.

“We’re committed to holding providers accountable when they put greed ahead of patient care.”

The FBI echoed those concerns, with Special Agent in Charge Matthew Fodor stating that kickback schemes remain a top investigative priority.

“We’re here to protect the American people—including from fraudulent actions that endanger federal healthcare systems.”

Whistleblower’s Tip Leads to Accountability

The case was brought to light thanks to a whistleblower who filed a lawsuit under the False Claims Act’s qui tam provision, which allows private individuals to sue on the government’s behalf.

As part of the resolution, the whistleblower will receive $116,850 from the settlement.

Gulfcoast Eye Agrees to Help with Broader Investigation

As part of the agreement, Gulfcoast Eye has also committed to cooperating with the Justice Department’s ongoing investigation into others involved in the alleged fraud.

Authorities noted that a similar scheme had already been resolved with another Florida-based ophthalmology clinic tied to the same TCD provider.

Federal Agencies Coordinated on the Investigation

This civil settlement came as the result of a joint effort involving the U.S. Department of Justice’s Civil Division, the U.S. Attorney’s Office for the Middle District of Florida, the FBI, and the Office of Inspector General for the U.S. Department of Health and Human Services.

Trial Attorney Nelson Wagner and Assistant U.S. Attorney Mamie Wise handled the case.

False Claims Act Remains a Key Tool in Fighting Healthcare Fraud

Officials emphasized that this case is another example of how the government is leaning on the False Claims Act to crack down on fraud, waste, and abuse in the healthcare system.

Anyone with knowledge of possible misconduct involving federal healthcare funds is encouraged to report it to HHS at 1-800-HHS-TIPS (800-447-8477).

No Admission of Guilt, But Allegations Stand

It’s important to note that while the case has been settled, Gulfcoast Eye has not admitted liability.

The claims resolved by this agreement are still considered allegations.