U.S. Attorney's Office for the Southern District of Texas issued the following announcement on Sept. 29.
A South Texas doctor has agreed to pay $3,234,900.50 to resolve allegations he fraudulently submitted claims to the Medicare program for medically unnecessary tests and procedures, announced U.S. Attorney Ryan K. Patrick.
Dr. David Mora is an optometrist who owns the Mora Eye Clinic in Laredo.
The U.S. Attorney’s Office (USAO) conducted a proactive analysis of claims data and determined Mora to be one of the most significant statistical outliers in the nation for certain categories of claims.
From Jan. 1, 2013, to June 14, 2019, Mora billed Medicare for medically unnecessary punctal plug insertion, sensorimotor testing, vision therapy/orthoptics and amniotic membrane placement. Medical need did not appear to support many of the claims. The patient’s condition did not warrant the service or test or many treatments were repeated on the same patient more often than what would be medically reasonable or necessary.
As part of the settlement, Mora and the Mora Eye Clinic agreed to a three-year integrity agreement with the Department of Health and Human Services – Office of Inspector General (DHHS-OIG). The agreement promotes compliance with the statutes, program requirements and written directives of Medicare and all other federal health care programs. Among other compliance obligations, Mora and the clinic must establish and maintain a compliance program and engage an independent review organization to perform quarterly claims reviews. The agreement also requires Mora and Mora Eye Clinic to routinely report on these obligations to DHHS-OIG.
The USAO jointly conducted the investigation with FBI and DHHS-OIG. Assistant U.S. Attorney Brad Gray handled the matter.
Original source can be found here.