Mass. Optometrist Focused on Trip to House of Correction Following Fraud Scam

An optometrist from Sharon, Massachusetts has been sentenced to three years in the House of Correction after pleading guilty to defrauding $373,000 from health insurance companies, Attorney General Tom Reilly announced.

Harvey G. Schneider, 60, of Sharon, pleaded guilty in Suffolk Superior Court to nine counts each of filing false health claims and larceny over $250, three counts of attempted larceny, and one count of practicing optometry after license suspension.

Judge Thomas Connors sentenced Schneider to a total of three years in the House of Correction, with three years probation following his jail term. Schneider was also ordered to pay $373,000 in restitution. Schneider’s commitment was stayed until July 1, 2005, at which time he will begin serving his sentence.

Schneider, an optometrist who practiced out of offices in Concord and Randolph, was indicted by a Suffolk County grand jury on Dec. 19, 2002 for defrauding nine health insurers and health maintenance organizations out of more than $350,000 in benefit payments through a variety of fraudulent schemes.

In one scheme, Schneider reportedly billed insurers for services he falsely claimed to provide when he did not actually treat the patients or provide the particular services.

In a second scheme, Schneider billed insurers for medical tests that he did not perform, including needle oculoelectromyographies, an invasive procedure in which a needle is inserted into the patient’s eye muscle under topical anesthesia. Dr. Schneider was reportedly not qualified to employ topical anesthesia and patients did not receive the procedure.

Health insurers rely upon doctors to provide accurate codes on health insurance claim forms to expedite processing. Each code corresponds with a specific reimbursement rate. Separate codes exist for comprehensive eye examinations of new vs. established patients. The reimbursement rate for a new patient, defined as a patient the doctor has not treated within the prior three years, is higher than the rate for an established patient.

In a third scheme, Schneider repeatedly coded as “new” examinations for established patients and, as a result, received more in reimbursement than he was due.

In the fourth scheme, Schneider was reported to have disguised services that were not reimbursable as covered treatments in order to obtain payment from insurers. Such non-reimbursable treatments included routine eye exams, contact lens fittings, and sports vision enhancement exercises. In an attempt to conceal the fraud, Schneider attributed the service claims as treatments of medical conditions which the patients in fact did not have, such as conjunctivitis, eye pain, and headaches.

Schneider served as optometrist for numerous New England Patriots players for many years. Schneider reportedly employed all four of these illegal schemes in defrauding the team’s insurance carrier and eight other insurers and health maintenance organizations between 1996 and 2002.