Ophthalmology Services: Questionable Billing and Improper Payments per Medicare

The Office of the Inspector General (OIG) reports that Medicare is vulnerable to fraud, waste, and abuse for wet Age-related Macular Degeneration (wet AMD) and cataracts:

  • Administration of Lucentis injections for wet AMD more than once every 28 days (based on local coverage determinations)
  • Billing for a second cataract surgery on the same eye
  • Submitting disproportionately more claims for complex than standard cataract surgery

Review the following resources for proper claims coding, billing, and payment:

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