According to court documents filed in U.S. District Court, Jeffrey Sponseller billed Medicare more than $800,000 between January 2008 and February 2011, much of it based on lies.
Sponseller, 47, the owner of Eye Care One at 3152 Washington Road, came to the attention of federal agents when they received complaints about his billing practices, FBI special agent Paul Kubala testified Wednesday.
Agents reviewed hundreds of records from Sponseller’s business obtained after a search in early 2011. Employees, former employees and witnesses at nursing homes throughout Georgia were interviewed during the investigation, Kubala testified.
They found that Sponseller was the highest recipient in the United States of Medicare payments for one specialized billing procedure.
His total billing for that procedure was 143 percent higher than the next top biller, Kubala said.
Sponseller had a speciality practice for nursing home patients.
Standard medical procedures are coded for billing practices in the United States. The code that Sponseller billed under repeatedly was for a comprehensive evaluation and treatment examination of a nursing home resident.
The procedure must take at least 45 minutes to perform, Kubala said.
On a single day – July 27, 2009 – Sponseller claimed in bills submitted to Medicare that he had seen 177 residents for that extensive evaluation at a nursing home in Americus, Ga.
If the minimum 45 minutes was spent with each patient, it would take nearly 133 hours to complete.
U.S. District Court Judge J. Randal Hall accepted Sponseller’s guilty plea. He allowed Sponseller to remain free on a $25,000 signature bond with the standard restrictions for defendants awaiting sentencing in federal court.
Sponseller was granted permission to travel to Florida for a planned vacation.
Sponseller, who lives in a Martinez home valued at more than $566,000, has been a licensed optometrist in Georgia since May 2004.
His license, according to the secretary of state’s professional license online search, is still in good standing.
A sentencing date has not been set. Medicare fraud is punishable by a maximum five-year prison sentence.