Opticians are required to follow specific prescriptions and are not allowed to alter prescriptions from licensed physicians and optometrists.
CareSource claims in its suit that during an audit, workers said that from Aug. 3, 2015, to Feb. 10, 2020, that Optical Options and its business owner, Colini, “provided an unusually high number” of aspheric lenses to CareSource members.
The audit apparently triggered further investigation by CareSource, which requested 72 random claims.
According to CareSource’s claim, none of those patients contained a prescription for aspheric lenses and as a result Optical Options was overpaid $403,490 in improper billing.
CareSource said the optician improperly submitted 6,532 claims for those services.
Colini and Optical Options, through an attorney, denied CareSource’s findings in a Aug. 8, 2020, letter sent to CareSource. The defendents said that Colini did not exceed his authority. A redacted copy of the letter is attached to the public court documents.
Neither Colini nor his attorney responded to requests for comment. A CareSource representative said the organization didn’t have anything more to comment beyond the court documents.
CareSource claims it didn’t get a response from the optician’s office in response to its final determination letter, sent Jan. 15.
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