Center for Public Integrity: Medicare being cheated of millions for cosmetic eyelid surgery

by Ben Vernia | May 28th, 2013

Following a review of Medicare payments to physicians for blepharoplasty, or eyelid surgery, the non-profit Center for Public Integrity reported on May 28 that eyelid surgery costs tripled in the decade from 2001 to 2011. The costs for 2011 amounted to $80 million. Although Medicare pays for some blepharoplasty procedures, it excludes operations performed for purely cosmetic reasons, CPI reports.

The watchdog group identified 11 of the top 20 billing physicians as Florida doctors, including one whose rate of claims would require him or her to perform six operations each day, every day of the week.

One former Medicare official described the difficulty of policing these claims:

Dr. Bruce Quinn, who served as Medicare medical director of California’s Medicare Part B program from 2004 to 2008, said monitoring blepharoplasty claims is notoriously difficult. When a claim is reviewed, Quinn said, staff receives a medical record from a doctor that says a patient’s eyelids interfered with their vision, along with a photo of someone with droopy eyelids. There really isn’t anything to review, Quinn said. “It’s really hard to go much further on that.”

It’s also difficult and expensive to take blepharoplasty cases to court if a provider is suspected of fraudulent billing, Quinn said. To make a case, the prosecution requires patient testimony and boxes of records, a bar that is hard to meet. Quinn said although the explosion of blepharoplasty caught his attention in California, it was “pretty slippery to get a handle on.”

Leave a Reply

Recent Posts

Recent Comments