Deeper Than the Headlines: Medicare Billing Violations Lead to $790K Settlement

An eye care organization in Pennsylvania recently agreed to pay $790,000 to resolve allegations of submitting improper Evaluation & Management (E&M) claims alongside bilateral eye injections. The violations, which occurred between 2018 and 2025, involved billing for same-day services in a way that breached Medicare’s rules. The OIG is also taking a closer look at these practices, too. 

This case is another reminder that even routine services—like E&M visits—must be coded and billed according to strict guidelines. When documentation doesn’t match claims, or when reimbursement rules are overlooked, the consequences can be costly. 

Compliance isn’t just about avoiding fines; it’s about protecting patient trust and the integrity of the system.