10/06/2012 04:05 EDT | Updated 12/05/2012 05:12 EST

Eyewear store focus of probe into phoney health claim allegations: report

OTTAWA - A defunct Ontario eyewear store linked to a businessman who was jailed for a year and fined millions of dollars for contempt is facing allegations it fleeced the aboriginal health-benefits plan, a newly released document shows.

Health Canada is trying to recover money from a former Great Glasses franchise that allegedly broke the rules for billing the Non-Insured Health Benefits program — including listing the name of a machine as the prescribing doctor on some of its billings.

The Hamilton store at the centre of the allegations was once part of former Ontario optician Bruce Bergez's now-defunct chain across southern Ontario.

Bergez spent a year in jail and owes nearly $17 million in fines for contempt of court for flouting Ontario's health laws.

Only optometrists and physicians can prescribe eyeglasses in Ontario, and only opticians can dispense them. But the report says the Great Glasses store at 1550 Upper James St. in Hamilton "did not have any physicians, optometrists or opticians working within their stores to dispense eyewear," in contravention the NIHB program's framework for vision care.

After years of legal wrangling, Bergez was sentenced to a year in jail and fined millions for contempt of court. His wife, Joanne, was sentenced to six months of house arrest.

Bergez founded the chain but says all locations were independently owned and operated by various franchisees who registered with the NHIB program independently.

In an email exchange, Bergez said he is unaware of the latest allegations against a part of his former eyeglasses empire.

He also said that he provides a more affordable alternative to "cartel controlling the sale of eyeglasses and contact lenses in Canada."

The claims have emerged as part of a months-long investigation by The Canadian Press into allegations of wrongdoing involving federal money for aboriginal health-care.

The allegations in the Health Canada audit team's September 2011 report are made against a single former Great Glasses franchise in Hamilton.

The investigation arose from some eye doctors complaining to Health Canada that the store used their names without their knowledge or consent when submitting claims to the NIHB program, the report says.

"It was confirmed that Great Glasses was using prescribers' names without their knowledge and illegally dispensing eyewear to NIHB clients," the report says.

The NIHB program provides health-benefit coverage to eligible First Nations people and Inuit when they are not insured by private or provincial plans.

The audit team further alleges the store wrote down the name of a machine called either Dr. Eyelogic or Dr. Ilogic as the prescribing doctor on several of its billings.

"(Health Canada's Audit and Accountability Bureau) noticed seven billings that listed a name of a machine as the prescriber instead of an authorized ophthamologist or optometrist," the report says.

"Further discovery noted that Great Glasses did not have any physicians, optometrists or opticians working within their stores to dispense eyewear. This contravenes the NIHB Vision Care Program Framework, the well-established professional standards and the applicable laws of Ontario.

"The sample reviewed by (the Audit and Accountability Bureau) indicates that the majority of the claims submitted by Great Glasses are deemed non-eligible for reimbursement under NIHB Vision Care Program."

Health Canada auditors looked at a sample of 85 claims to the NIHB program made by the Hamilton store between April 2004 and May 2009.

The auditors found 15 of the claims totalling $1,935 were "potentially fraudulent," the report says.

Forty-five claims amounting to $6,374 were "inappropriately billed," the document adds. The report says another 14 claims were accepted and 11 more were not paid.

The government is now trying to recover $8,309, the report says.

The Canadian Press obtained a copy of the 13-page report under the Access to Information Act.

Health Canada said it has not yet recovered any of the money.

"Health Canada has not initiated legal action at this time and is examining its options," spokeswoman Christelle Legault said in an email.

Bergez, who spent a year in jail between October 2010 and October 2011, said Health Canada has not spoken to him about the allegations in the auditors' report.

"If Health Canada wants to discuss this matter with me, HC and I can have a fulsome chat on the report in person," he said in an email.

Bergez has resurrected the Great Glasses brand in British Columbia — where the laws are different than in Ontario. He said he has no knowledge of the allegations against the store in Hamilton.

"This is the first I have seen the report. It is interesting reading, however I do not have any knowledge of these claims," he said.

"All locations were independently owned and operated by various franchisees who registered with the NHIB independently. I have had no involvement with the Ontario operations since July 2010, one year before this report was authored."

In 2010, the Ontario government appointed Deloitte and Touche to take control of the Great Glasses stores in Ontario and the assets of Bergez and his wife, Joanne.

It is not clear from the Deloitte and Touche documents who owned the Hamilton franchise. Bergez declined to answer questions on the matter.

"I have moved on with my life. I have no interest in speaking with you about this matter any further," he said.

"However, if Health Canada wishes to have a conversation with me, as I agreed, I would be more than willing to discuss this matter with them."

A Deloitte and Touche document identifies Glen Friday as the operator of the former Great Glasses store at 1550 Upper James St. in Hamilton. He now owns a 3 for 1 Glasses store at that same location.

Friday said he wasn't the owner of the Great Glasses store during the April 2004 to May 2009 period covered by the Health Canada report.

"I was the store operator but not for the whole time indicated," he said in an email.

Friday declined an interview request. But he said that his 3 for 1 Glasses store operates to the "letter of the law," and no one from the federal government has ever contacted him about the allegations contained in the Health Canada report.