Pacific Eye Institute Agreed to Pay $599,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Provided as Claimed or Not Medically Necessary

After it self-disclosed conduct to OIG, Pacific Eye Institute, a Medical Group, Inc. (PEI), Upland, California, agreed to pay $599,742.09 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that a physician employee of PEI billed for performing gonioscopies (eye examinations that use specialty gonio lenses to check for signs of glaucoma) that were either not performed or were performed without the necessary gonio lens. Further, OIG alleged the same physician billed for amniotic membrane treatments for “dry eye” using techniques that were outside of the standard of care (including without the use of a bandage contact lens) which would likely have rendered the treatment ineffective and often did not maintain documentation sufficient to support the medical necessity of these treatments.

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