Eye Care Clinics Pay More than $500,000 in Medicaid Fraud Cases

Medicaid has rules in place designed to ensure that members of low-income households receive appropriate healthcare. The stability of the system depends on eliminating unnecessary costs so that funds are available for the people who need them. Sadly, some medical providers try to take advantage of the claims process to benefit themselves.

In Colorado, Attorney General Phil Weiser has reached a settlement with two eye care clinics stemming from allegations of Medicaid fraud. One provider, Apex Vision and Wellness, is paying $280,000. The settlement amount is $240,000 in the case against Just for Grins Vision. Colorado’s Medicaid Fraud Abuse and Neglect Unit investigated the clinics based on claims filed from 2019 to 2025. 

Under Medicaid standards, beneficiaries who are younger than 20 years old can receive a set of two lenses if they have qualifying vision difficulties. Depending on the particular case, the lenses can be either spherical or aspherical. According to the Attorney General’s office, the clinics created aspherical lenses for patients who required them, but also billed Medicaid for spherical lenses that they never made. Weiser’s statement says that both businesses engaged in this type of fraud more than 1,800 times. 

Given the massive workload of government healthcare programs such as Medicaid and Medicare, it is not surprising that certain schemes often go undetected. Apex and Just for Grins might have escaped attention because the authentic aspherical lenses in these cases are more expensive than the spherical lenses named in the phony claims.

Employees of medical offices are frequently the source of tips that are critical in foiling healthcare fraud schemes. Whether the particular case involves claims for unnecessary equipment, the use of improper billing codes, procedures that offer no medical benefit or something else, whistleblowers can make an enormous positive difference. They might also be able to collect a monetary award if their diligence results in a financial recovery by the government. 

Kardell Law Group is a leader in the representation of whistleblowers, including those who identify instances of Medicaid and Medicaid fraud. For a consultation regarding what you know and how you could secure an award through qui tam litigation, please call or contact us online.