Leonard C Boyle, Acting United States Attorney for the District of Connecticut, and Phillip Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of the Inspector General, today announced that LISA AZINHEIRA and L.A. VISION LLC, have entered into a civil settlement agreement with the federal and state governments and have agreed to pay $678,901.21 to resolve allegations that they violated the federal and state False Claims Acts.
Azinheira is a licensed optician and an owner of L.A. Vision, a business located on South Whitney Street in Hartford that offers optical goods and services. The allegations against Azinheira and L.A. Vision concern the submission of claims for optical goods and services that were not medically necessary.
The government alleges that starting in January 2014, every time Azinheira and L.A. Vision billed Connecticut Medicaid for a pair of eyeglasses, they also submitted a claim to Medicaid for “miscellaneous vision services or items,” using procedure code V2799. Pursuant to the Department of Social Services (“DSS”) fee schedule, procedure code V2799 can only be billed for medically necessary vision services, and must be billed at actual acquisition cost. The United States and the State of Connecticut allege that Azinheira and L.A. Vision did not provide any services or items that would justify billing that procedure code, and if any services or goods were provided, they were not medically necessary, and not billed at acquisition cost.
The government also alleges that starting in January 2014, Azinheira and L.A. Vision encouraged Medicaid beneficiaries under the age of 21 to choose up to three pairs of eyeglasses at a time. Relevant Medicaid guidance indicates that spare pairs of eyeglasses are not medically necessary and are not covered. The federal and state governments contend that Azinheira and L.A. Vision knowingly submitted false claims to Medicaid for multiple pairs of eyeglasses that were not medically necessary.
To resolve the allegations under the federal and state False Claims Acts, Azinheira and L.A. Vision have agreed to pay $678,901.21 to the federal and state governments for conduct occurring between January 1, 2014, and November 10, 2018.
As part of the settlement, Azinheira and L.A. Vision have entered into a three-year billing Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of federal healthcare programs.
This matter was investigated by the Office of the Inspector General for the Department of Health and Human Services, and the Connecticut Office of the Attorney General. This case was prosecuted by Assistant U.S. Attorney Sara Kaczmarek, and by Assistant Attorney General Gregory O’Connell of the Attorney General’s Office.