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Attorney General Jason R. Ravnsborg

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Optometrist Settles Healthcare Case with South Dakota and United States


FOR IMMEDIATE RELEASE :   Tuesday, October 1, 2013
CONTACT:  Sara Rabern (605)773-3215   

Optometrist Settles Healthcare Case with South Dakota and United States

PIERRE, S.D  -   South Dakota Attorney General Marty Jackley, United States Attorney Brendan V. Johnson, and Gerald Roy, Special Agent in Charge, United States Health and Human Services, Office of Inspector General (HHS-OIG) jointly announce that the State of South Dakota and the U.S. have reached a settlement with a Rapid City optometrist in a civil case involving health care overpayments.

The agreement with M. Scott Ellender, OD, resolves allegations that Ellender knowingly submitted false claims to Medicaid, Medicare, and TRICARE. The government alleged that Ellender submitted improper claims to Medicaid for bifocal lenses, trifocal lenses, and new patient visits, and claims to Medicaid, Medicare and TRICARE for medically unnecessary Visual Field Examinations during the period from June 1, 2006, through December 31, 2012.
Ellender will pay $283,499 to settle the allegations. As part of the settlement, Ellender and his practice, Budget Optical, will enter an Integrity Agreement with HHS-OIG.  
According to the Settlement Agreement, Ellender denies the allegations made by South Dakota and the U.S., but settled the case without admitting liability to avoid the delay, uncertainty, inconvenience, and expense of protracted litigation. As part of a separate agreement with South Dakota, Ellender also spoke to a group of providers about this case. Ellender will also provide free eye care to underserved patients for one year.
The case was handled by the South Dakota Attorney General’s Medicaid Fraud Control Unit, the Office of U.S. Attorney for South Dakota, HHS-OIG, and TRICARE, with assistance from the South Dakota Department of Social Services.