The OIG has issued a report entitled “Questionable Billing for Medicare Ophthalmology Services.” The OIG concludes that most Medicare providers billing for ophthalmology services in 2012 did not demonstrate what the OIG characterizes as questionable billing practices, such as a high percentage of claims for complex cataract surgery or Lucentis injections beyond maximum annual dosing recommendation per eye. Nevertheless, 4% of providers billing Medicare for ophthalmology services demonstrated at least one of the OIG’s questionable billing practices, and Medicare paid 1,726 providers a total of $171 million for services “associated with” such practices. The OIG points out that there may be legitimate reasons why some of the providers engaged in what it characterizes as questionable billing, but the OIG contends such providers warrant additional scrutiny. The OIG therefore recommends that CMS increase monitoring of ophthalmology services billing and review the billing of the providers identified by the OIG. CMS concurred with these recommendations.
