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CT AG Settles L.A. Vision for $678,901 Medicaid Overbilling

L.A. VisionAugust 13, 2021Connecticut Attorney General

Penalty Amount

$678,901

Summary

Connecticut Attorney General William Tong announced a $678,901 settlement with L.A. Vision and optician Lisa Azinheira for overbilling the state Medicaid program. The providers billed for non-medically necessary vision services and extra eyeglasses for children. In addition to restitution, they must comply with a federal Integrity Agreement requiring audits, training, and compliance measures.

Remedy

L.A. Vision must pay $678,901, comply with a U.S. Health and Human Services Office of Inspector General Integrity Agreement requiring training, education, and compliance measures, engage an independent review organization to audit Medicaid claims, and cover all compliance costs. Violations may result in additional penalties or exclusion from government healthcare programs.

Monetary PenaltyAudit RequirementCompliance Program

Contract Impact

In-house legal teams should review vendor and service provider agreements, particularly those involving government healthcare programs like Medicaid. Focus on clauses governing billing and reimbursement, including requirements that services be medically necessary and billed at acquisition cost. Examine audit rights, compliance certifications, and termination provisions. Consider adding specific definitions of medical necessity, mandatory training obligations, independent audit requirements mirroring the Integrity Agreement, and clear restitution mechanisms for overpayments. Also review any clauses related to pediatric or dependent services to prevent billing for non-covered items.

Contract Search Terms

Medicaid reimbursement ratesmedical necessity certificationgovernment program billing clauseclaims audit rightscompliance program requirementspediatric service limitationsfee schedule adherencerestitution for overpaymentsindependent review organizationtraining and education obligations

Violation Types

Entity Details

Entity

L.A. Vision

Industry

Healthcare

Official Sources

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