Transamerica Occidental Life Insurance Company for Audit of Medicare Claims by Optometrists for Comprehensive Nursing Facility Assessments for Calendar Years 1995 through 1998

This final report presents the results of our audit of claims by optometrists for comprehensive nursing facility (CNF) assessments during Calendar Years 1995 through 1998. We found that optometrists were not licensed to perform CNF assessments. Nonetheless, optometrists submitted claims totaling $1,759,492 for these services, and Transamerica paid them $957,366 for their claims. We recommended that Transamerica: (1) issue a reminder to optometrists to bill Medicare only for services performed within the scope of their licenses; and (2) implement computer payment edits to prevent payment to optometrists for CNF assessments. Transamerica representatives agreed with our audit findings and recommendations, and have implemented the recommended corrective actions. We have requested that Transamerica not seek recovery of the overpayments at this time as we are still evaluating the issue.