NCPA - National Center for Policy Analysis

Medicare Makes $22 Million in Improper, Eye-Related Payments

December 31, 2014

In 2012, Medicare paid $8.2 billion for eye-related insurance claims -- specifically, for cataracts, wet age related macular generation and glaucoma. But according to a report from the Department of Health and Human Services' Office of the Inspector General, $22.3 million of that spending may have been for tests, treatments and services that were "potentially inappropriate."

The government report analyzed Medicare claims data from 2012. Of 49 million claims for services related to cataracts, wet AMD and glaucoma, the government found that despite federal laws preventing payment for certain claims, Medicare paid more than $14 million for 68,837 claims prohibited by those federal laws. For example, Medicare paid $8.6 million for 10,560 cataract surgeries on eyes that had already had cataract surgeries that year. According to the report, it is "medically impossible to have more than one cataract surgery per eye," because cataract surgery permanently removes an eye's lens. As such, federal law prohibits more than one payment for cataract surgery on an eye. Even so, one health care provider was paid almost $60,000 for 69 cataract surgeries on eyes that had already had cataracts removed.

While most providers filing eye-related claims did not receive potentially improper payments, there were 12 providers that received 14 percent of the improper payments identified in the report.

Source: Sarah Westwood, "Medicare gave eye doctors millions to remove cataracts that didn't exist," Washington Examiner, December 30, 2014. 


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