An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis

Prior OIG work found that Medicare inappropriately paid for services that were billed as being distinct or significant and separately identifiable from other services provided on the same day. Our analysis showed that in 2018, an ophthalmology clinic in California (the Clinic) frequently billed for other services as being unrelated to, distinct from, or significant and separately identifiable from intravitreal (inside the eye) injections of the drugs Eylea and Lucentis.Our objective was to determine whether the Clinic complied with Medicare requirements when billing for intravitreal injections of Eylea and Lucentis and for other services provided on the same day as the injections.