HARTFORD, Conn. — A Hartford-based optician and service provider were ordered to pay $678,901 over allegations of Medicaid fraud. The offices of the state and U.S. Attorneys General announced the joint settlement Friday.
The allegations claimed that L.A. Vision and Lisa Azinheira 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 and services.
The investigation then found that none of the items or services provided were medically necessary. Additionally, L.A. Vision did not bill them at their acquisition cost, which does not follow Medicaid requirements.
L.A. Vision billed CMAP for multiple pairs of eyeglasses for children, the investigation discovered, and Medicaid doesn't cover extra pairs of eyeglasses that aren't medically necessary.
Even so, for years L.A. Vision encouraged children to pick out multiple pairs of eyeglasses. They then billed CMAP for the extra eyeglasses even if they weren't medically necessary.
As part of the settlement, L.A. Vision and Azinheira have entered into the U.S. Health and Human Services Office of the Inspector General Integrity Agreement imposing training, education, and compliance requirements.
The service provider will be required to engage an independent review organization to review and audit their Medicaid claims.
Both parties must pay the costs of complying with the Integrity Agreement, where violations could result in additional monetary penalties and exclusion from participation in government healthcare programs.
“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," DSS Commissioner Deidre S. Gifford said. Her agency administers Medicaid in Connecticut.
“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,” Connecticut Attorney General William Tong said.
He also 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 joint participation in negotiating this settlement.
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