Essilor International, Essilor of America Inc., Essilor Laboratories of America Inc. and Essilor Instruments USA, manufacturers and distributors of eye care products, will pay $16.4 million to resolve claims that they violated the False Claims Act. The case arose from denunciations of three former district commercial directors of Essilor: Laura Thompson, Lisa Brez and Christie Rudolph.
The who tam provisions of the False Claims Act allow private citizens to sue on behalf of the government if they know of an individual or company that is defrauding the government. Who tam whistleblowers are eligible to receive between 15 and 30% of government recovery, where applicable.
According to the settlement agreement, “Essilor International is an international company which, through its various subsidiaries, designs, manufactures, markets and distributes eye care equipment and products, including optical lenses, and provides various eye care services”. Essilor of America, Inc. and Essilor Laboratories of America, Inc. are “wholly owned subsidiaries of Essilor International which, among other things, manufacture and distribute optical lenses to independent eye care providers” nationwide. During the time period at issue in the case, “Essilor Instruments USA was a subsidiary of Essilor International which, among other things, manufactured and distributed cutting and finishing equipment, as well as other optical instruments, intended for used at retail in-store by “independent eye care providers, or “Providers,” as they are referred to in the Settlement Agreement.
The whistleblowers alleged, among other things, that Essilor, what the various entities are collectively referred to, “offered illegal bribes to suppliers in exchange for suppliers agreeing to order optical lenses from Essilor. “, reads the settlement agreement. According to the US Department of Justice (DOJ) press release, the government “alleged that between January 1, 2011 and December 31, 2016, Essilor knowingly and deliberately offered or paid compensation to eye care providers, such as optometrists and ophthalmologists”. , to induce these suppliers to order and purchase Essilor products for their patients, including Medicare and Medicaid beneficiaries, in violation of anti-kickback law.
The anti-kickback law prohibits the payment of bribes “to induce or reward patient referrals or the generation of business involving any item or service payable by federal health care programs.” Laws like this are meant to maintain the integrity of federal health care programs and ensure that health care professionals make decisions based on the best interests of patients, not the compensation they might receive.
The United States also alleges “that Elissor knowingly caused suppliers to submit false claims to Medicare and Medicaid for Essilor products that were tainted with bribes that Essilor offered or paid to suppliers” who were involved in “threshold programs” between January 1, 2011 and December 31. , 2016. Threshold programs were named Strategic Alliance, Practice Builder Loyalty, Practice Builder Elite and Growth Financing.
According to the settlement agreement, the three whistleblowers in the case “seek the right…to a share of the proceeds of this settlement agreement and to Relators’ reasonable expenses, fees and attorneys’ fees.” The document states that “Essilor reserves the right to challenge the rights of the Relators” to the aforementioned items.
Essilor will pay $22 million to the United States and Medicaid participating states. $16,433,345.01 will go to the United States, in accordance with the settlement agreement.
Essilor has also “entered into a five-year Corporate Integrity Agreement (CIA)” with the Office of the Inspector General of the Department of Health and Human Services. The agreement requires Essilor to “engage an independent review body to review its systems, policies, processes and procedures to ensure that all rebates, rebates or other price reductions offered to suppliers comply with the Anti-Corruption Act. -bribes”. To comply with the CIA, Essilor must also “implement a new written review and approval process to ensure that all existing and new rebate agreements comply with the Anti-Kickback Act. “.
Whistleblowers are key to uncovering corruption and wrongdoing in the health sector: fraudulent schemes can be particularly harmful to patients and erode trust in the medical system. In fiscal year 2021, who tam whistleblowers helped the DOJ recover $1.6 billion in settlements. The DOJ pointed to health care fraud as “the primary source of the department’s settlements and judgments under the False Claims Act.”
Read the press release here.
Read the settlement agreement here.
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