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Eyecare Provider Sentenced to 3+ Years in Prison for Medicare and Medicaid Fraud

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The fraud totaled more than $1M, authorities said.

GAINESVILLE, GA — An eyecare provider in Georgia has been sentenced to three years, four months in prison for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided.

Matilda Lynn Prince, 42, was convicted by a jury of 29 counts of healthcare fraud, according to a press release from the U.S. Attorney’s Office for the Northern District of Georgia.

“Prince will now spend time in federal prison for stealing over a million dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak. “Prince diverted critical resources away from the elderly and low-income families who were most in need of care.”

According to Pak, the charges and other information presented in court: Prince owned Pickens Eye Clinic in Jasper, GA, and operated Eye Gallery 20/20 in Calhoun, GA. From September 2011 to February 2014, Prince submitted false claims to Medicare and Medicaid for optometry and ophthalmology services that were never rendered to patients.

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Despite being previously excluded from the Medicare and Medicaid programs in September 2011 and informed of her ineligibility to be employed or involved with any entity that received Medicare or Medicaid funds, Prince operated under a company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered, authorities said. As part of the scheme, Prince targeted her advertising towards senior citizens and disabled populations in housing complexes and community centers, offering on-site eye exams and prescription glasses at no charge to patients on Medicare and Medicaid, the release stated. Prince contracted with two licensed optometrists to provide basic eye exams, according to the release, and the optometrists would sometimes travel with Prince to perform these exams.

Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures involving the surgical insertion of medical devices called “punctal plugs” into patients’ tear ducts to treat dry eye conditions, authorities said. Prince then used the identities of the two licensed optometrists to bill Medicare and Medicaid repeatedly for this procedure. On some occasions, she allegedly billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed.

Prince was accused of fraudulently submitting over $1.2 million in insurance claims to Medicare and Medicaid for services never rendered.

 

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