Medicare Funding Eyelid Lifts – Possible Insurance Fraud?

The media has been all over this one.  Statistics are showing that the number of people utilizing Medicare to pay for upper eyelid lifts has increased significantly.  From Salon.com:

From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. In 2001, physicians billed taxpayers a total of $20 million for the procedure. By 2011, the price tag had quadrupled to $80 million. The number of physicians billing the surgery more than doubled.

“With this kind of management malpractice, it’s little wonder that the [Medicare] program is in such dire shape,” said Sen. Tom Coburn (R-Okla), who is also a physician. “The federal government is essentially asking people to game the system. Every dollar we spend on cosmetic surgery that isn’t necessary is a dollar that can’t be used to shore up the program for people who need it the most.”

Plastic surgeons say there are a number of legitimate reasons for the spike, including a tendency among the elderly to seek fixes for real medical issues they might have quietly suffered through even a decade ago. But surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals, and advertising often including dramatic before-and-after photographs that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicare’s requirement that peripheral vision actually be impaired.

In my practice, I haven’t seen an increase in the number of seniors having this covered by Medicare.  Medicare has specific guidelines for what is needed to get an eyelid lift covered.  That being said, it’s possible for some patients (and doctors) to game the system by falsifying visual field testing.  I’ve had more than one patient ask me to bill insurance for their eyelid lift when it’s not indicated.  I just tell them that I don’t commit fraud.

Here is a video I did for Fox News of an eyelid lift that was billed to insurance (appropriately!):

For more on this story, visit Salon.com.
 

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Posted in: Plastic Surgery News, Plastic Surgery Video


Responses:

  1. The real disconnect is really with the criteria required to get insurace coverage. Typically ophthalmologists perform visual field testing which is required to document a significant visual field impairment due to heavy upper lids. The problem is that opthalmologists also often perform the blepharoplasty surgery. That is the real problem. As a plastic surgeon, I rely on an accurate visual field test to determine if a patient fulfills the criteria for an “insurance covered” blepharoplasty. I have no input into those results.

    The issue is one of conflict of interest. The doctor performing the test needed to meet the requirements for insurance coverage also performs the surgery. I would love to see how many insurance covered blephs are done by ophthalmologists vs plastic surgeons.

    Comment by Dr Hainer on June 4, 2013 at 6:57 pm

  2. I suspect that most eyelid lifts are done by real plastic surgeons, but I’ve never seen any numbers regarding this.

    Comment by Editor on June 5, 2013 at 2:54 am

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