Several opticians have been earning money on the side by
promoting specific lenses. What should the owner do?

New Jersey practice Duplaiss Vision Center was in a large suburban town with a reputation for excellent physicians and reasonable prices. Doctor-owner Stan Duplaiss employed 10 seasoned professionals and trusted them to make good decisions while he  focused on patient care.

One afternoon Dr. Duplaiss was opening the mail and found a beat-up envelope from one of their lens companies addressed to one of his opticians who had recently moved. His mailing address had been crossed out and the office’s address written in. Through the plastic window Dr. Duplaiss could see it was a check and  assumed it was erroneously sent to an employee and not to him. When he opened it, however, he found a check for $260 written to the employee. Was it a refund for a return? At a loss for an explanation, the doctor called him into his office.

“Lynn, I opened a check I assumed was for the practice, but it’s for  you. What is it for?” asked Dr. Duplaiss.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.

ABOUT THE AUTHOR

NATALIE TAYLOR is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com..

“Oh, that’s for lenses I sold last month,” Lynn said casually, reaching out to receive the envelope.

“I don’t understand. Why are you receiving money from a lens company?” the doctor asked, placing the envelope on the desk in front of him.

Lynn paused. “It’s an incentive program. Our rep helped everyone get set up online,” he said.

“I had no idea,” Dr. Duplaiss confessed. “Why didn’t anyone tell me?”

Lynn looked uncomfortable, and said, “I assumed you knew ...”

Dr. Duplaiss looked at the check, gathering his thoughts. He finally said: “I’d like all the opticians to come in here. Tell the patients they’re with that I need them for five minutes.”

Lynn left the room and returned with his three coworkers, all alarmed at the unusual summons. Dr. Duplaiss addressed the room.

“It has come to my attention that you are participating in a kickback program with our lens companies,” he began. The energy in the room shifted to panic. “I haven’t had enough time to research this, but I have to say, it feels very unethical. What would your patients think if they knew you were being rewarded for recommending certain products?” Dr. Duplaiss said.

After a pause, Lynn spoke again. “Since we don’t get a commission or sales bonus, we assumed this was to make up for it,” he said, “but none of us wanted to do anything wrong or unethical.” The group nodded, fearful of losing this income.

“How much money are we talking about here?” Dr. Duplaiss asked.

Their eyes darted to the floor in feigned concentration. “I think I average $300 a month,” said one.

“Yes, about that,” said another.

Dr. Duplaiss frowned. “When did this start?”

There was a long silence before Lynn confessed, “A few years ago.” 

“OK, thank you for being honest. Get back to the patients. I’ll need the numbers for all our lens reps so I can make some calls,” Dr. Duplaiss said.  

He couldn’t help but feel like a theft had occurred, but he didn’t know who to hold accountable.

 

THE BIG QUESTIONS

      1. Should the opticians pay back the practice for the money they received?
      2. Would you hold the opticians responsible for this error, even though there was no explicit office rule against incentive payments?
      3. If you were Dr. Duplaiss, would you fire the lens companies? Would you fire the opticians?

 

Expanded Reader Responses

Dennis I.
Monroe, CT 

First, if there is no written policy against kickbacks, make it an addendum to the employee handbook and have everyone sign it. Second, meet with each rep for a personal explanation. Third, insist all checks go directly to the office, and if they want to keep their product there, they better give me an incentive to keep it.

Kenneth S.
Ft. Mitchell KY 

The problem is that the program was not addressed to the doctor/business owner initially. Rebate programs are great, and I don’t have a problem if the rebate goes directly to the employee, but the doctor/business owner needs to know because it affects payroll/benefits. The opticians can keep the rebates, but they need to know that it ultimately belongs to the office and will be transferred back to it upon their leaving. As well as knowing that they are factored in to how their total compensation is determined. 

Monica M.
Bakersfield, CA 

First, the doctor should not feel that there was any wrong doing. If there was,  it’s from the doctor for not offering incentives and for not being educated on the lenses being recommended. Recommendation of lenses by opticians should be because of lens quality and not just the incentive though.

1. The opticians shouldn’t pay back the money. The checks were made out to them not the doctor.

2. There was no error. Especially since there is no rule against receiving incentives.

3. I wouldn’t fire anyone. It is not unethical to recommend lenses, especially if you believe in them.

Casimiro G.
Bell, CA

I would contact the reps and have them make all future “kick back” payments to the doctor and use that money for office parties or end-of-year bonuses to the staff. Why leave money on the table?

David G.
Beckley, WV 

This was dishonest of the employees. The doctor owns the business and should make all business arrangements. He should check with his accountant; he may have been paying the taxes on his employees’ incentives. He also probably paid higher prices for lenses than he should to fund them. The doctor was cheated out of money that should have been for his business. Very dishonest.

A.J. S.
Houston, TX 

Considering that all the opticians participated, I would suggest no punishment. A review of cost factors needs to be done to ensure ROI and patient satisfaction were equal and no misguidance was offered. Also, a discussion with the reps to find out when and why this started and if a 1099 was necessary. The receipt of income should be reported. If this is to be considered gifts from the reps to the opticians, then the doctor should be delighted at the increase to his bottom line.

Rick R.
Girard, PA

I don't think the opticians should have to pay the money back to the office. How was the doctor not aware of a particular brand of lens being sold by his entire staff, for three years? I think patients could care less. I worked at a chain for years and you sold what they told you to sell, which was a handful of lenses. Did patients get weird about that? No. I do think the opticians made an error in not letting the Doc know they were involved in an incentive program. If they wanted spiffs they should have talked to the Doc long before this. "Doc, would you mind if we received incentives for X brand lenses?" I wouldn't fire either, but he needs to sit down and address the issue and try and find a resolution that benefits everyone.

Gigette H.
Washington, NJ

I am curious as to why the opticians are getting bonuses from the contact lens companies in the first place especially in New Jersey. The doctor is the professional who suggests, fits, and prescribes the contact lenses in New Jersey. An optician would only fill the contact lens prescription once written. Opticians in New Jersey can not fit or prescribe contact lenses. They would just order the boxes of lenses. This scenario should not be happening in New Jersey. If it were occurring, I would feel very, very uncomfortable.

Spectacle lenses and options like anti-reflective coating, transitions, etc is another matter. If the staff receives incentives for these, I have no problem with that. Your staff works hard, they should be rewarded. The doctor should always be informed by the lens representative of incentive programs. However, contact lenses are a different animal all together.

Teresa D
Poplar Bluff, MO

I would not fire anyone. The employees are probably selling premium products to get the kickback. I think the Dr. should have known about this from the beginning and was in agreement.

Louis M.
Spartanburg, SC

There are many companies, including optical labs and contact lens manufacturers, that reward practices with a percentage rebate on the sales that the practice does with their company. We regularly received rebates from these companies. We take these checks and add them to the bottom line of our production for the month. Our office has a profit sharing program based on growth in revenues each month. The staff is rewarded with a bonus when a certain production is done each month. Indirectly, they benefit from using certain optical products over others, but no employee is rewarded individually. There is no direct kickback to a specific employee but they are rewarded as a whole, a team.

Angel M.
CYNTHIANA, KY

I don’t think the opticians should be fired, or have to pay the money back via garnishing wages, etc. However, any type of bonuses in the future should be forfeited until the amount is made up. If there was nothing in the staff manual about kickbacks, the doctor really doesn’t have a lot to punish them for, BUT the fact that no one thought, including the lens reps, to inform the doctor is very indicative of the shadiness of this set up. Lens needs are as individual as the patient and a kickback is a horrible idea. I am an optician in a private practice and at our office we realize that the optician isn’t the only one selling the glasses. The sale starts when the patient makes the eye exam appointment. Reps are told from the get go that the doctor ultimately is paying for everything, not the optician/frame stylist, so any extras really do belong to the doctor. Any extras from frame companies, etc., go into a pool. When there is enough for everyone to get something, we all draw a number from a bowl and get the corresponding numbered gift. That way there is no hurt feelings, no sneaking with reps, and no favoritism shown. 

Gigette H.
WASHINGTON, NJ

I am curious as to why the opticians are getting bonuses from the contact lens companies in the first place, especially in New Jersey. The doctor is the professional who suggests, fits and prescribes the contact lenses in New Jersey. An optician would only fill the contact lens prescription once written. Opticians in New Jersey cannot fit or prescribe contact lenses. They would just order the lenses. This scenario should not be happening in New Jersey. If it were occurring, I would feel very, very uncomfortable. Spectacle lenses and options like anti-reflective coating, transitions, etc. is another matter. If the staff receives incentives for these, I have no problem with that. The staff works hard and should be rewarded. The doctor should always be informed by the lens representative of incentive programs.

Michelle W.
stockbridge, GA

The first thing I'd want to know is who is negotiating the lens contract with the lab? If the doctor made those decisions, he has to be accountable for not making sure all reps were given notice of his plan for business. The fact that it has been going on for two years lets us know the doctor is sadly out of the loop. Then I'd call in the lens reps and speak with them directly. I would ask specific questions on who gave them permission to incentivize your team. If they did not speak with a manager and made this decision independently, I would call their managers in. The opticians should not have to pay the money back or be held responsible for the incentives. You can not be held to a standard you are unaware of. The doctor should have a conversation followed up by policy that explains his expectations regarding incentives given by vendors.

Robert M.
edina, mn

The opticians should not be forced to return the money unless the expectation had been set that all incentives (spiffs) would go to the practice. The opticians should not be held responsible in this case. Should they have asked about it when it was presented? Yes. I would have a meeting with the opticians and lay out some rules and expectations. I would also ask them what they would think a commission bonus structure would look like. The one I would suggest would be based on capture rate and be paid out to the entire clinical staff. I would then call all the sales managers for the lens companies and give them the new protocol. It wouldn't hurt to ask them how much they had paid out to the opticians. There may be some tax ramifications here as the incentives may have been assigned to the clinic. I would not fire the opticians or the lens companies.


 This article originally appeared in the February 2017 edition of INVISION.

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