Eye-care provider convicted in $1.2 million scam

Eye-care provider convicted in $1.2 million scam | Insurance Business

Eye-care provider convicted in $1.2 million scam
A Georgia eye-care provider has been convicted on 29 counts of healthcare fraud for scamming $1.2 million from Medicare and Medicaid programs.

Matilda Lynn Prince, who owned Pickens Eye Clinic in Jasper, Ga., and operated Eye Gallery 20/20 in Calhoun, Ga., was convicted on charges connected to submitting fraudulent claims, according to US Attorney Byung J. Pak.

“Prince stole hundreds of thousands of dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” Pak said.

“The Medicaid program is designed to provide benefits to some of the most vulnerable members of our community and depends on the integrity and honesty of those providers who bill Medicaid,” said Georgia Attorney General Christopher M. Carr. “When a provider bills Medicaid for services they did not provide, they victimize and take advantage of the people who need it the most.”

According to Pak’s office, between 2011 and 2014, Prince submitted false claims to Medicare and Medicaid for optometry and ophthalmology services she never provided to patients. When she was excluded from Medicare and Medicaid programs in September 2011, Prince opened a new company, Eye Gallery 20/20, to bill the programs for services that weren’t provided. As part of the scam, she targeted her advertising toward senior citizens and disabled populations in housing complexes, offering on-site eye exams and prescription glasses at no charge to patients enrolled in Medicare or Medicaid.

While patients received only basic exams and measurements for prescription glasses, Prince often billed for complex procedures involving surgery. On some occasions, she billed the same patient up to seven times on the same claimed date of service, the US Attorney’s Office said. She fraudulently submitted more than $1.2 million in insurance claims to Medicare and Medicaid.

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