State settles with optometrist accused of over billing

A Sioux Falls optometrist has agreed to settle allegations that he overbilled the state’s Medicaid program, Attorney General Marty Jackley announced today.

Dr. Jeff Browen, who owns Advanced EyeCare, was accused of overbilling by performing medically unnecessary tests and by billing for procedures that should have been billed under a different, less expensive code. Medicaid is a health program for the poor that is funded by taxpayers.

Advanced EyeCare will pay $151,528.89 as part of the settlement agreement. Under the terms of the settlement, Browen did not admit wrongdoing.

"We are working to protect taxpayer dollars by ensuring that providers submit claims for goods and services that are medically necessary," Jackley said in a release announcing the settlement. "It is important to guard taxpayer monies by paying only legitimate claims."

Agents with the Division of Criminal Investigation raided Browen’s South Minnesota Avenue office in 2012, seizing records related to the investigation.

Browen has also been entangled in civil litigation with Wellmark of South Dakota over similar allegations. In 2014, Browen sued Wellmark after the insurance provider stopped paying for procedures being billed by his office. Wellmark countersued, alleging that Browen billed for services that were not medically necessary and which did not support the level of care patients received.

At issue is Browen’s use of a billing code for an expensive prosthesis known as a scleral cover shell. Wellmark and the state argued that Browen was providing services that should have been billed under a code for contact lenses – a code which has a lower payment rate.

In his lawsuit against Wellmark, Browen says that Wellmark paid the higher rate from 2007 to 2012 when it abruptly stopped. Nine other insurance companies, his lawsuit says, still reimburse him under the more expensive code, and he accuses the company of breaching his provider contract and acting in bad faith.

Wellmark has sued to recover money it paid to Browen under the disputed billing code.

“The services provided by Dr. Browen were not reasonably or medically necessary for the patients’ diagnosis,” the lawsuit says.