What Prosecutors Allege Happened to Patients
Federal prosecutors have charged the founder of a New Jersey eye care group with running an eight-year scheme in which Medicare patients preparing for eye surgery were given diagnostic tests that, according to the indictment, nobody involved in their care ever looked at.
The Justice Department announced a seven-count indictment against E. Bruce DiDonato, 71, of Princeton, New Jersey, the founder and former chief executive of Campus Eye. The charges include conspiracy to commit health care fraud, conspiracy to violate the Anti-Kickback Statute, two counts of health care fraud and three counts of illegal kickbacks.
According to court documents, from at least 2015 through March 2023, DiDonato allegedly conspired to defraud Medicare by billing for unnecessary diagnostic eye tests performed at a surgery center. Prosecutors allege patients were subjected to tests that either duplicated tests they had already received or were unnecessary for the type of surgery being performed.
The detail that matters most for patients is what allegedly happened after the tests. Prosecutors say neither DiDonato nor the optometrist reviewed the results, and in most instances the ophthalmologists did not review or rely on them when making treatment decisions.
DiDonato has been charged, not convicted. An indictment is an allegation, and he is presumed innocent unless and until proven guilty.
Why Unnecessary Testing Costs Patients Directly
Older adults sometimes assume that unnecessary testing is a problem for taxpayers rather than for them. That is not quite right, and this case illustrates why.
Most diagnostic services under Medicare Part B involve patient cost sharing after the annual deductible is met. When a test is billed, the beneficiary generally owes a share of the approved amount. A patient who received duplicative tests across multiple visits may have paid repeatedly for information that, as alleged here, was never used.
There is also a cost that does not appear on any statement. Testing takes time, often requires extra appointments, and can produce a sense that a condition has been thoroughly evaluated when the results were never examined. False reassurance is harder to measure than a copay, but for someone weighing eye surgery, it is the more consequential harm.
Prosecutors allege approximately $3.4 million in fraudulent claims were submitted to Medicare, of which Medicare paid approximately $1 million. Those figures describe the program's loss. They do not capture what individual patients paid in coinsurance, which the indictment does not quantify.
How the Alleged Scheme Worked
The mechanism prosecutors describe explains why the testing volume allegedly grew.
According to the indictment, DiDonato paid kickbacks and bribes to ophthalmologists in exchange for referring patients who needed eye surgeries. He then allegedly subjected those referred patients to the diagnostic tests at issue.
Prosecutors allege the payments were concealed through sham agreements describing them as consulting fees, and were paid as monthly flat fees that were in fact calculated as a percentage of the optometry practice's Medicare reimbursement for diagnostic tests performed on patients those providers had referred the previous year.
That structure, if proven, would mean a referring physician's payment rose as testing on their referred patients rose. The indictment further alleges that DiDonato marketed and sold Campus Eye to private equity investors based in part on the Medicare reimbursements the practice was generating.
"Medicare patients deserve care guided by medical need, not illicit financial arrangements," said Naomi D. Gruchacz, Special Agent in Charge at the Department of Health and Human Services Office of Inspector General. The FBI's Newark office described the alleged conduct as "a scheme rife with disregard for the rules" governing medical practice.
The Company Avoided Prosecution and the Founder Did Not
The same announcement contained an unusual second element that readers following health care enforcement should understand.
The Justice Department resolved its criminal investigation into Campus Eye Management Holdings LLC and its subsidiary Campus Eye Management LLC by declining to prosecute the companies. Prosecutors cited the companies' voluntary self-disclosure of the misconduct and their remediation. The companies agreed to pay $1 million to victims.
Campus Eye is the first health care company to receive a declination under the department's new corporate enforcement policy, and reportedly only the second declination overall in a criminal health care fraud investigation. The earlier one involved a Florida Medicare benefits provider that self-reported and paid $53 million in restitution.
For patients, the practical significance is limited but real. A declination is not a finding that nothing happened. It reflects a decision about who to charge. The $1 million victim payment is separate from any outcome in the criminal case against DiDonato.
What Medicare Patients Can Do Now
The useful response to a case like this is not alarm about eye care generally. Diagnostic testing before eye surgery is routine and often necessary, and this indictment concerns one practice.
The concrete step available to any Medicare beneficiary is to read the Medicare Summary Notice that arrives quarterly, or to check claims online through a Medicare account. Look for tests you do not remember receiving, the same test billed more than once in a short period, or services on dates you were not at a clinic. Patients in Medicare Advantage plans should review their Explanation of Benefits the same way.
Anyone who spots something unexplained can call the number on the notice, or contact 1-800-MEDICARE. State Senior Medicare Patrol programs offer free help reviewing statements for beneficiaries who find the paperwork difficult. Suspected fraud can be reported to the HHS Office of Inspector General at 1-800-HHS-TIPS.
Patients scheduled for eye surgery can reasonably ask their surgeon which tests are being ordered, what decision each test will inform, and whether any test duplicates one already done. That is a fair question in any specialty, and a surgeon who cannot answer it is worth a second opinion. No one should cancel or delay medically indicated surgery or testing because of a fraud case involving a different practice.
The confirmed fact is that a seven-count indictment has been filed and a corporate declination granted. The people most affected are older adults treated at the practice between 2015 and 2023. The most reasonable action is reviewing Medicare statements for tests that were never explained. The central uncertainty is the outcome of the case, since the allegations remain unproven. The next expected development is DiDonato's arraignment and any subsequent court schedule.
Frequently Asked Questions
What is the defendant accused of doing? Prosecutors allege he conspired to bill Medicare for diagnostic eye tests that were duplicative or unnecessary, and paid kickbacks to ophthalmologists for patient referrals.
Has he been convicted? No. He has been indicted, which is an allegation. He is presumed innocent unless and until proven guilty in court.
Which patients were affected? Medicare patients referred for eye surgery who received diagnostic testing at the surgery center between at least 2015 and March 2023.
Did patients pay anything? Medicare Part B diagnostic services generally involve patient cost sharing after the deductible. The indictment does not quantify what individual patients paid.
How do I check my own Medicare claims? Review your quarterly Medicare Summary Notice or your online Medicare account. Medicare Advantage members should review their Explanation of Benefits.
Where do I report suspected Medicare fraud? Call 1-800-MEDICARE or the HHS Office of Inspector General at 1-800-HHS-TIPS. State Senior Medicare Patrol programs offer free assistance.
Should I be worried about eye tests before surgery? Testing before eye surgery is routine and often necessary. It is reasonable to ask which tests are ordered and what decision each one informs.
