United States attorney announces fraud settlement with ophthalmologist, practice

A West Virginia ophthalmologist has reached a settlement with the U.S. Department of Justice to settle allegations that his practice submitted false claims to Medicare and Medicaid.

Craig Morgan, MD, and Eye Consultants of Huntington, West Virginia, have paid $907,074.64 to resolve allegations that they submitted false claims to Medicare and Medicaid, the Justice Department said in a Sept. 6 news release.

According to the Justice Department, from January 13, 2013, through April 12, 2019, Morgan administered vascular endothelial growth factor inhibitor injections into the eyes of patients to treat purported wet age-related macular degeneration or other ophthalmological conditions. Prosecutors said these injections were not medically necessary because the patients did not have treatable Wet-AMD or other conditions that would have warranted the invasive treatment.

“This settlement is important because it shows that this office, along with its federal partners, will aggressively seek re-imbursement when taxpayer money is spent wrongly,” United States Attorney Will Thompson said in a statement. “When a person goes to a medical provider, they expect the medical provider to treat them, not for the medical provider to figure out ways to enrich themselves.”

Morgan was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers. The vast majority of payments Morgan received from Medicare were for injections for purported treatment of wet-AMD.

“Providers who perform medically unnecessary procedures damage the trust of physician-patient relationships and exploit taxpayer-funded programs,” said HHS-OIG Special Agent in Charge Maureen Dixon. “HHS-OIG, and our law enforcement partners, are committed to working together to protect the integrity of federal health care programs.”

The case was investigated by HHS-OIG and the Federal Bureau of Investigation in collaboration with the United States Attorney’s Health Care Fraud Task Force, which brings together federal, state, and local law enforcement partners from numerous agencies to coordinate intelligence sharing and prosecution of health care fraud impacting Medicare, Medicaid, and other public health care programs.