Essilor Pays $16.4M After Violating Medicare, Medicaid Kickback Rules

The company has been ordered to hire an independent review organization to review its systems, policies, processes and procedures.

I Stock 928085588

Essilor International, Essilor of America Inc., Essilor Laboratories of America Inc. and Essilor Instruments USA, headquartered in Dallas, have agreed to pay $16.4 million to resolve allegations that the company violated the False Claims Act by causing claims to be submitted to Medicare and Medicaid that resulted from violations of the Anti-Kickback Statute. 

Essilor manufactures, markets and distributes optical lenses and equipment used to produce optical lenses. The United States alleged that between Jan. 1, 2011, and Dec. 31, 2016, Essilor knowingly and willfully offered or paid remuneration to eye care providers, such as optometrists and ophthalmologists, to induce those providers to order and purchase Essilor products for their patients, including Medicare and Medicaid beneficiaries, in violation of the Anti-Kickback Statute. The Anti‑Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by Medicare, Medicaid and other federally-funded programs. The statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives.

“Our healthcare system is predicated on providers making decisions solely in the best interest of the patient,” said U.S. Attorney Jacquelin Romero of the Eastern District of Pennsylvania. “Kickbacks threaten to corrupt that decision-making.  The U.S. Attorney’s Office stands ready to pursue anyone who fails to abide by the rules that ensure our system functions as it should.”

“Kickback schemes can impact medical judgment, eroding the trust of both patients and taxpayers,” said Lisa M. Re, Acting Chief Counsel at the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Essilor’s Corporate Integrity Agreement is intended to establish policies and practices so it complies with the Anti-Kickback Statute moving forward.”

In connection with the settlement, Essilor entered into a five-year Corporate Integrity Agreement (CIA) with HHS-OIG. The CIA requires, among other things, that Essilor hire an independent review organization to review its systems, policies, processes and procedures for ensuring that any discounts, rebates, or other reductions in price offered to providers comply with the Anti-Kickback Statute. The CIA also requires Essilor to implement a new written review and approval process to ensure all existing and new discount arrangements comply with the Anti-Kickback Statute.