Cataract Surgery: Fraud, Waste, and Abuse. A Report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session.

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104

Policymakers

Accountability; Cost Effectiveness; Eyes; Federal Programs; Fraud; Government Role; Health Needs; Older Adults; Ophthalmology; Special Health Problems; Surgery; Visual Impairments

This report is a summary of the findings from the Subcommittee on Health and Long-Term Care of the United States House of Representatives Select Committee on Aging investigation of cataract surgery and the use of intraocular lenses (IOL's) in the United States. The document provides background on the definition and treatment of cataracts and describes IOL implantation procedures, the IOL industry in the United States and abroad, and IOL utilization, including numbers and costs. Medicare payment for cataract surgery is also examined. Current problems are detailed, including efficacy and safety; cost; kickbacks, discounts, and rebates; and no cost advertisements. Results from surveys of ophthalmologists and the IOL industry regarding their experiences with fraud, waste, and abuse in the area of cataract surgery are analyzed and a conversation with an IOL salesman is reported. Current regulatory activity involving IOL enforcement, approval, and reimbursement is detailed. Policy recommendations, based on the findings, are listed and supported by the conclusion that cataract surgery is fraught with fraud, waste, and abuse but can still be provided with some improvements in program administration and legislative changes. A glossary of terms specific to the cataract industry and an anatomy of the eye are included. Several appendices present surveys of ophthamologists and the IOL industry, information supplied by the Food and Drug Administration and the Health Care Financing Administration, and marketing materials of the IOL industry. (ABB)

1986

ED265468