Two ophthalmology practices pay $2.3M over allegedly false diagnoses billed for transcranial Dopplers

Two New York ophthalmology practices, Fromer Eye Centers and Floral Park Ophthalmology, agreed to pay a combined $2.3 million on July 31, 2026 to settle False Claims Act allegations that they billed Medicare and Medicaid for medically unnecessary transcranial Doppler ultrasounds. The alleged pattern is the kind a coder or biller can check for on their own claims: a diagnosis assigned to make a test payable, then billed when the record never supported it.

What the government alleged

The United States alleged that the practices, Mark D. Fromer, P.C. doing business as Fromer Eye Centers and Floral Park Ophthalmology P.C., performed transcranial Doppler ultrasounds (TCDs) on thousands of patients through a kickback arrangement with a third-party testing company, and billed Medicare and Medicaid hundreds of dollars per test. Before patients received their results, the practices and the testing company allegedly identified those patients as having a serious diagnosis that could qualify them for reimbursement of a TCD. According to the government, nearly all of the patients never had that diagnosis, and it was not reflected in the patient's medical history or in the TCD results. Floral Park Ophthalmology allegedly received payments from the testing company to induce it to refer its Medicare and Medicaid patients for the tests.

Those are the government's allegations. DOJ states the claims resolved by the settlements are allegations only and there has been no determination of liability. Both practices agreed to cooperate with the Justice Department's ongoing investigations of other participants in the alleged scheme.

Both are civil settlements with no determination of liability. Of the $2.3 million total, $384,000 goes to New York for its Medicaid share.

The diagnosis has to live in the record, not in the coverage rule

Medicare pays for a transcranial Doppler study (the CPT family 93886, 93888, 93890, 93892, and 93893) only when the record carries an ICD-10-CM diagnosis that supports medical necessity for it. CMS spells that out in its Billing and Coding article for transcranial Doppler studies, which lists the diagnoses that establish coverage. The government says the alleged scheme ran that logic backward. A qualifying diagnosis was picked first and attached to patients who did not have it, so the test would clear.

The tell in a chart is a diagnosis that shows up only on the claim, or only after a referral, and never in the history, the exam, or the assessment, and that the test's own result does not bear out. A covered indication is something a clinician documented about the patient before the order went in. The record either shows that or it does not.

The kickback thread runs underneath it

The government also alleged violations of the Anti-Kickback Statute and the Stark Law. Under the Anti-Kickback Statute, a claim that results from a prohibited referral payment is a false claim on its own, whether or not the test itself was performed correctly. That is the thread connecting the pieces the government described: a testing company paying to steer referrals, and the test volume that followed. When a referral is bought, the diagnosis and the medical necessity behind it stop being the reason the test happened, and the whole claim is exposed.

One in a string of TCD settlements

The settlement is not the first in this matter. DOJ says it previously resolved similar allegations against Brandon Eye Associates, Pinellas Eye Care doing business as Gulfcoast Eye Care, and five other ophthalmology practices, all over the same alleged transcranial Doppler arrangement. It echoes the Access DX genetic-testing settlement announced this week, a different test and a different scheme built on the same idea: a third-party testing company, a paid referral stream, and claims the government says were medically unnecessary. The government is working its way through a referral network, and the two practices here agreed to help. If your practice sits near one of these outside testing arrangements, treat that as a reason to audit your own diagnostic-test claims now rather than after a letter arrives.

How the case surfaced

The settlements resolve a lawsuit filed under the False Claims Act's qui tam whistleblower provisions, which let a private party sue on the government's behalf and share in the recovery. The whistleblower will receive approximately $132,000 in connection with the Fromer Eye Centers settlement. The matter was handled by the Civil Division's Commercial Litigation Branch, Fraud Section, and the U.S. Attorney's Office for the Middle District of Florida, with help from HHS-OIG and the FBI.

Where this lands on a coder's desk

This is a Medicare and Medicaid diagnostic-test billing matter, not a risk-adjustment case, so nothing here touches your HCC mappings or RAF weights. It lands on anyone who codes or bills diagnostic tests, and on whoever owns the order sets and the outside-testing arrangements. The self-audit is short. For each covered diagnosis on a test claim, confirm it appears in the record independent of the test with MEAT-level support, and confirm a treating provider ordered the test for a documented, patient-specific reason. The principle is the same one RADV enforces on the risk-adjustment side. A diagnosis with no support in the note is an overpayment waiting to be found, whether the code clears a TCD or an HCC. When the record only shows the referral, a compliant provider query before the claim goes out beats an appeal after it.