Attorney General Tong Announces $678,901 Overbilling Settlement With L.A. Vision
(Hartford, CT) – Attorney General William Tong today announced a $678,901 joint state and federal settlement with L.A. Vision and optician Lisa Azinheira resolving allegations that the Hartford-based vision care service provider overbilled the state Medicaid program for vision care services and eyeglasses.
A joint state and federal investigation found that from January 1, 2014 through November 10, 2018, L.A. Vision routinely billed the Connecticut Medical Assistance Program for “miscellaneous” items/services. The investigation found that none of the items or services provided were medically necessary. Moreover, to the extent any items/services were provided, L.A. Vision did not bill for them at their acquisition cost contrary to Medicaid requirements.
The investigation also found that L.A. Vision billed CMAP for multiple pairs of eyeglasses for children. Medicaid does not cover extra pairs of eyeglasses that are not medically necessary. Nevertheless, L.A. Vision encouraged children to pick out multiple pairs of eyeglasses, and subsequently billed CMAP for the extra eyeglasses, regardless of medical necessity.
In addition to the $678,901 payment, L.A. Vision and Azinheira have entered into a U.S. Health and Human Services Office of the Inspector General Integrity Agreement imposing training, education, and compliance requirements. L.A. Vision will be required to engage an independent review organization to review and audit their Medicaid claims. L.A. Vision and Azinheira must pay the costs of complying with the Integrity Agreement. Violations of the Integrity Agreement could result in additional monetary penalties and exclusion from participation in government healthcare programs.
“L.A. Vision overcharged Connecticut’s Medicaid program for vision care services and eyeglasses that were not medically necessary. In addition to a $678,901 restitution payment, they will be required to comply with strict compliance terms to ensure the integrity of their billing going forward. In conjunction with our federal and state partners, we are prepared to act aggressively against anyone who misuses our state healthcare programs,” said Attorney General Tong.
“This settlement will return nearly $679,000 to the Medicaid program and serves as a warning that enrolled providers must adhere to program integrity requirements in billing practices and medical necessity standards. I join in thanking Attorney General Tong and his staff, our federal and state investigatory and law enforcement partners, and Department of Social Services (DSS) quality assurance investigators for their excellent work on this case,” said DSS Commissioner Deidre S. Gifford, whose agency administers Medicaid in Connecticut.
Attorney General Tong thanked the U.S. Health and Human Services Office of the Inspector General/Office of Investigations, the Office of the United States Attorney, the Connecticut Medicaid Fraud Control Unit, and the DSS Office of Quality Assurance for their coordination in this matter.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to firstname.lastname@example.org.
Forensic Fraud Examiner Lisa Bailey and Assistant Attorney General Gregory K. O’Connell, under the supervision of Deputy Associate Attorney General Jeremy Pearlman, Chief of the Antitrust and Government Program Fraud Section, assisted the Attorney General with this matter.