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International

Million-dollar fraud nets prison term for eyecare provider

03/10/2018
An eyecare provider has been sentenced to federal prison after a jury found her guilty of 29 counts of healthcare fraud totalling more than US$1.2 million (AU$1.64 m).

According to the US District Attorney’s Office, Matilda Lynn Prince, 42, submitted false claims to Medicare and Medicaid for ophthalmology and optometry services that were never provided to patients. Prince received a three year, four month sentence as a result of the fraud, which took place between September 2011 and February 2014.

“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,” US Attorney Mr Byung Pak said.

“Prince diverted critical resources away from the elderly and low-income families who were most in need of care.”


"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"
Byung Pak, US Attorney

Prince owned and operated two businesses in Georgia – Pickens Eye Clinic in Jasper and Eye Gallery 20/20 in Calhoun, which served as fronts for the fraud scheme.

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 to bill Medicare and Medicaid.

As part of the scheme, Prince targeted her advertising towards senior citizens and disabled populations in housing complexes and community centres, offering on-site eye exams and prescription glasses at no charge to patients on Medicare and Medicaid.

Prince contracted two licensed optometrists, who would sometimes travel with Prince to perform basic eye exams.

Although the patients received only basic eye exams and measurements for prescription glasses, Prince often billed for complex ophthalmological procedures, including the surgical insertion of punctal plugs. Prince used the identities of the two optometrists to bill Medicare and Medicaid repeatedly for this procedure.

Sometimes, 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.

Prince was also ordered to pay US$609,000 (AU$837,000) in restitution.

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