Transamerica Occidental Life Insurance Company for Audit of Medicare Claims by Optometrists for Comprehensive

Department of Health and Human Services OFFICE OF INSPECTOR GENERAL TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY AUDIT OF MEDICARE CLAIMS BY OPTOMETRISTS FOR COMPREHENSIVE NURSING FACILITY ASSESSMENTS FOR CALENDAR YEARS 1995 THROUGH 1998 THIS REPORT IS AVAILABLE TO THE PUBLIC at __ OAS FINDINGS AND OPINIONS GIBBS BROWN Inspector General SEPTEMBER 1999 A-09-99-00095 -- -- -- --DEPARTMENT OF HEALTH HUMAN SERVICES CIN: A-09-99-00095 September 30, 1999 Mr. Ed VelascoMedicare AuditLos Angeles, CA 90015-2211Dear Mr. Velasco:The purpose of this letter report is to provide Transamerica Occidental Life Insurance Company (Transamerica) with the results of our audit of claims by optometrists for through 1998. Our objectives were to determine whether optometrists’ medical licenses permitted them to perform CNF assessments and whether Transamerica had paid optometrists for these services which were outside the scope of their licenses. Nonetheless, optometrists submitted claims totaling for these services, and Transamerica paid them $957,366 for their claims. 98 percent of the $957,366. (1) issue a to optometrists to bill Medicare only for services performed within the scope of their licenses; and assessments. In a written reply to our draft report, Transamerica representatives agreed with our entirety as Appendix A, except we excluded Transamerica’s documentation audit findings and recommendations. Transamerica’s comments are ...