Opportunities To Reduce Medicare Payments for Prosthetic Lenses While Enhancing Nationwide Uniformity of Benefits

Gao ID: HRD-85-25 January 10, 1985

GAO discussed two opportunities for reducing the large number of Medicare payments for prosthetic eye lenses after cataract surgery and for ensuring that beneficiaries are provided with consistent benefits.

GAO found that some of the Medicare beneficiaries who have cataract surgery later obtain multiple replacement prosthetic lenses. GAO found that, because Medicare regulations do not establish specific limits on the number of replacement lenses for which it will pay, limits among the carriers varied from stringent limits to none at all. GAO also found that physicians were receiving overly high payments for their services compared to allowed charges for other similar procedures. GAO estimates that improved guidance by the Department of Health and Human Services (HHS) could have resulted in a reduction in Medicare allowed charges of at least $7.4 million during 1982 in areas served under 7 of the program's 49 claims processing contracts.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195


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