• Invision Mag Staff

Eyecare Provider Convicted in $1.2M Fraud Case

She submitted claims for services not rendered, authorities said.

An eyecare provider in Georgia has been convicted by a federal jury of 29 counts of health care fraud.

Matilda Lynn Prince was accused of filing $1.2 million in fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients, according to a press release from the U.S. Justice Department.

"Through our partnership with the Georgia Attorney General’s office, we will continue to fight the costly effects of healthcare fraud in this state that divert critical resources away from citizens who truly need these services," said U.S. Attorney Byung J. “BJay” Pak.

Prince, 41, owned Pickens Eye Clinic in Jasper, GA, and operated Eye Gallery 20/20 in Calhoun, GA, according to the release. From September 2011 to February 2014, Prince submitted false claims to Medicare and Medicaid, authorities said.

A sentencing date has not yet been set.

According to the release:

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 receives Medicare or Medicaid funds, Prince operated under a new eye service company named Eye Gallery 20/20 to bill Medicare and Medicaid for services that were not rendered. 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. Prince contracted with two licensed optometrists to provide basic eye exams. 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. Prince then used the identities of these two optometrists to bill Medicare and Medicaid repeatedly for this procedure. On some occasions, she billed for the same patient as many as seven times on the same claimed date of service, even though the procedures were never performed.