The Colorado attorney general’s office announced Thursday that it has reached a $520,000 settlement with two eye care clinics accused of improperly billing the state’s Medicaid vision program for years.
According to the attorney general’s office, Apex Vision and Wellness and Just for Grins Vision submitted claims to Colorado Medicaid between 2019 and 2025 for two sets of specialized lenses per patient, despite providing only one set in practice.
Colorado’s Medicaid vision benefit allows patients under the age of 20 to receive one pair of frames and two lenses. State investigators alleged that the two clinics collectively submitted more than 1,800 claims seeking reimbursement for both aspherical and spherical lenses, even though patients received only the aspherical lenses.
“While the clinics did provide aspherical lenses for children, they also billed the state for unnecessary spherical lenses that were never created,” the attorney general’s office said in a news release.
Colorado Attorney General Phil Weiser said the alleged conduct resulted in repeated overbilling of the Medicaid program.
“We all pay the costs of Medicaid fraud,” Weiser said in a statement. “I am committed to protecting the integrity of the state Medicaid program, holding accountable any providers that fail to follow Colorado’s Medicaid laws, and protecting patients.”
An attorney for Apex Vision and Wellness disputed the state’s interpretation of the billing rules but said the clinic chose to resolve the matter to avoid prolonged litigation.
“Apex takes compliance obligations seriously and has cooperated with the Attorney General’s office,” said Ben Hudgens of Richards Carrington LLC. “While Apex disagrees with the Attorney General’s interpretation of certain billing requirements, it agreed to resolve the matter to avoid the cost and distraction of prolonged litigation.”
Just for Grins Vision did not immediately respond to a request for comment Thursday.
Under the settlement terms, Apex Vision and Wellness will pay $280,000 over four years, while Just for Grins Vision will pay $240,000 over three years.
The agreement marks the second recent settlement involving eye care providers accused of double-billing Medicaid for vision services. In September, the attorney general’s office announced a $250,000 settlement with Vista Eye Care over similar allegations involving nearly 3,000 claims.
