What Happened to the Other Allegations in the Ophthalmic Consultants of Boston Case?
In my last article, I looked at the whistleblower complaint that started the False Claims Act investigation into Ophthalmic Consultants of Boston.
The complaint caught my attention for a simple reason.
It described three different alleged schemes.
But when the case eventually settled for nearly $4 million, the government focused on only one of them.
So what happened to the other two?
The government’s recently unsealed intervention papers give us part of the answer.
But not all of it.
Three Allegations Became One
The whistleblower’s complaint alleged that Ophthalmic Consultants of Boston, or OCB, improperly billed government healthcare programs in three different ways.
The first involved **Modifier 25**, a billing code used when a physician performs a significant, separately identifiable evaluation and management service on the same day as another procedure.
The second alleged that physicians prescribed expensive eye medications, including Eylea and Lucentis, when a much less expensive medication called Avastin could have been used.
The third alleged that OCB received credit card reward points from purchases of some of those medications.
Those were allegations, not findings of wrongdoing.
And when the federal government and the Commonwealth of Massachusetts finally announced their decisions about the case, they drew a very clear line between them.
They intervened only in the Modifier 25 allegations.
They declined to intervene in the rest.
What Does That Mean?
False Claims Act cases work differently from ordinary lawsuits.
A whistleblower, known as a relator, can file a lawsuit on behalf of the government. The complaint initially remains under seal while the government investigates and decides what it wants to do.
At the end of that process, the government can choose to intervene and take over the prosecution of some or all of the claims.
Or it can decline to intervene.
Here, the federal and Massachusetts governments chose a third possibility.
They intervened in only part of the case.
Specifically, they intervened in the section of the complaint entitled **“OCB Uses Modifier 25 Fraudulently.”**
That part of the case was settled.
The remaining allegations weren’t.
And the Other Claims?
This is where the intervention notice becomes particularly interesting.
The whistleblower could potentially have continued pursuing claims in which the government declined to intervene.
That isn’t what happened here.
According to the government’s filing, the relator agreed to voluntarily dismiss the non-intervened claims, and the federal and Massachusetts governments agreed to that dismissal.
So the case that began with three different alleged schemes ultimately ended with a settlement involving one of them.
Why?
The public documents don’t tell us.
What We Do Know
We do know considerably more about the Modifier 25 allegations.
The settlement agreement states that OCB **“acknowledges, admits, and accepts responsibility”** for certain facts concerning its billing practices.
According to the agreement, between January 1, 2015 and July 30, 2025, OCB submitted Modifier 25 claims in connection with eye injections where the documentation did not support separate billing or where its ophthalmologists did not perform a significant and separately identifiable evaluation and management service.
OCB agreed to pay the federal government and Massachusetts a total of $3,902,588.28, plus interest.
The agreement also says OCB received credit for its cooperation, including accepting responsibility, assisting the governments with their damages analysis, and making significant improvements to its compliance practices and controls.
Those are significant details.
But they still don’t tell us what investigators concluded about the other allegations.
The Missing Part of the Story
Perhaps investigators found stronger evidence supporting the Modifier 25 allegations.
Perhaps the damages were easier to establish.
Perhaps the other allegations presented legal or factual problems.
Perhaps settlement negotiations played a role.
There are many possibilities.
But they would be speculation.
And there is another reason we may never know.
During the investigation, the government periodically submitted papers to the court explaining why the case should remain under seal while investigators continued their work.
When the case became public, the government specifically asked the court to keep those earlier papers sealed because they discussed the **“content and extent”** of the federal and state investigation.
The court agreed.
Those documents remain sealed.
They may contain some of the answers.
For now, the public record does not.
A Useful Lesson for Whistleblowers
There is a broader lesson here.
A whistleblower complaint may be the beginning of a False Claims Act case, but it doesn’t necessarily tell us what that case will eventually become.
Investigators may spend years reviewing documents, interviewing witnesses, analyzing billing data, consulting government agencies, and testing the allegations made in the complaint.
Some allegations may emerge stronger.
Others may not.
The government may intervene in everything, intervene in nothing, or—as happened here—intervene in only part of the case.
The complaint tells us where the investigation started.
The intervention decision tells us something about where it ended.
What happened in between is often the part we never get to see.
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*This article discusses allegations and proceedings contained in publicly filed court documents. Allegations in a complaint are not findings of liability. The federal and Massachusetts governments declined to intervene in certain claims discussed above, and those claims were to be voluntarily dismissed by the relator.*