Eye Clinics Pay $520K for Illegal Medicaid Billing

CO Attorney General Press Releases

Filed January 15th, 2026

Detected February 7th, 2026

Summary

Two Colorado eye clinics, Apex Vision and Wellness and Just for Grins Vision, have agreed to pay a combined $520,000 to resolve allegations of illegal Medicaid billing. The clinics are accused of overbilling for corrective lenses for children and young adults between 2019 and 2025.

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What changed

The Colorado Attorney General's office has announced a settlement with Apex Vision and Wellness and Just for Grins Vision, requiring them to pay a total of $520,000 to resolve allegations of defrauding the state's Medicaid program. The investigation found that from 2019 to 2025, both clinics billed Medicaid for two sets of corrective lenses for over 1,800 claims each, but only provided one set to child patients. Additionally, they allegedly billed for unnecessary spherical lenses that were never created.

This enforcement action highlights the critical need for healthcare providers to ensure accurate billing practices, particularly concerning Medicaid programs. Providers must adhere strictly to billing regulations and ensure that services billed are actually rendered and medically necessary. Non-compliance can lead to significant financial penalties and reputational damage. The settlement outlines specific payment schedules for each clinic, with Apex paying $280,000 and Just for Grins paying $240,000 over time.

Source document (simplified)

Eye care clinics agree to pay combined $520K over illegal Medicaid billing

Jan. 15, 2026 (DENVER) — Attorney General Phil Weiser today announced a settlement with Apex Vision and Wellness, a Greeley-based eye clinic, and Just for Grins Vision, a Fountain-based eye clinic, to resolve allegations that the clinics illegally billed the state’s Medicaid program for thousands of corrective lenses for children and young adults. Apex will pay a fine totaling $280,000 and Just for Grins will pay $240,000 under the agreements.

“We all pay the costs of Medicaid fraud. In these cases, the eye clinics regularly overbilled Medicaid for two sets of lenses—including sets of unnecessary special lenses—but delivered only one set to child patients.” said Attorney General Weiser. “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.”

Medicaid provides eligible Coloradans and their dependents with health care coverage, including vision coverage for children and young adults under the age of 20. Vision benefits include one pair of frames and two lenses. This includes lower-cost spherical lenses, which are for people with relatively lower prescriptions, and more expensive aspherical lenses, which are prescribed for those with higher prescriptions.

The investigation by the Medicaid Fraud Abuse and Neglect Unit within the Colorado Attorney General’s Office found that, from 2019-2025, Apex billed the state for two sets of lenses for more than 1,800 claims but provided only one set to patients. During the same period, Just for Grins also billed the state for over 1,800 claims but provided only one set to patients. While the clinics did provide aspherical lenses for children, they also billed the state for unnecessary spherical lenses that were never created.

Under the terms of the settlement agreement, Apex will pay the state $65,000 immediately and then follow up with four $53,750 payments, plus interest, on the anniversaries of the agreement. Just for Grins will pay $125,000 immediately and then follow up with three $38,333.33 payments, plus interest, on the anniversaries of the agreement.

The Colorado Medicaid Fraud Abuse and Neglect Unit receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,858,544 for federal fiscal year 2024. The remaining 25%, totaling $1,286,181, is funded by the state of Colorado for the federal fiscal year.

Those who have knowledge of or suspect Medicaid fraud are encouraged to file a complaint with the attorney general at StopFraudColorado.gov.

Read the Apex settlement agreement (PDF).

Read the Just for Grins settlement agreement (PDF).

Media Contact:
Lawrence Pacheco
Chief Communications Officer
(720) 508-6553 office
lawrence.pacheco@coag.gov

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