The Medicare program from 2021 through 2023 overpaid a select number of optometrists some $3 million for services provided to program enrollers in skilled nursing facilities, according to a new report issued this week by the Office of Inspector General (OIG) for the Dept. of Health and Human Services.

The OIG report, “Medicare Improperly Paid Selected Optometrists for Services Provided to Enrollees at Nursing Facilities” (December 2025 | A-05-24-00009), said it conducted the analysis after its data identified Medicare Part B payments made to optometrists for high-level evaluation and management (E/M) services that are not usually billed by optometrists.

“For 2021 through 2023, Medicare paid $4.7 million to 200 optometrists for E/M services for moderate to highly complex subsequent nursing facility care. The top 15 optometrists accounted for 72 percent of those payments,” OIG said.

The audit then examined whether the 15 optometrists complied with Medicare requirements when billing for services at nursing facilities.

OIG found they did not. “CMS [Centers for Medicare and Medicaid Services] reimbursed selected optometrists for Part B services that were not billed in accordance with Medicare requirements. All 225 of the enrollees we sampled had associated claim lines of service that did not meet Medicare documentation or coding requirements. All 399 lines of services billed as high level E/M codes for the sampled enrollees did not meet Medicare requirements,” the report said.

In turn, OIG estimates that Medicare overpaid the selected optometrists at least $3 million for E/M services during the audit period.

The three recommended fixes for the issue include that CMS recover the portion of the $3 million in estimated overpayments that are within the 4-year reopening period, increase claim reviews, and develop system edits to prevent the incorrect billing of services.

“CMS concurred with two recommendations. CMS did not fully concur with the third recommendation to increase claim reviews and develop system edits,” OIG said.

Read the entire OIG report at https://tinyurl.com/32yc83ut.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.