SAN ANTONIO – In a recent report, the Washington-based Center for Public Integrity found that Medicare spending for the cosmetic eyelid lift surgery has quadrupled over 10 years to $80 million, even though Medicare is not supposed to pay for cosmetic correction.
Some experts are now questioning whether thousands of people and their doctors could be taking advantage of the system.
Dr. Frank Fechner performs dozens of droopy eyelid surgeries each year.
"Over the past 10 years, I've probably performed about 1,000," Fechner said.
All but 26 of those were cosmetic procedures.
"Patients come and they feel that they look tired," Fechner said.
Under those circumstances, insurers, including Medicare, are not authorized to pay for the procedure. But the Center for Public Integrity found that the number of eyelid lifts charged to Medicare more than tripled over a 10-year span to 136,000 annually. The price tag for the procedure ballooned from $20 million to $80 million.
So is the desire for a more youthful appearance or medical necessity driving the dramatic increase?
Thomas Scully, a former Medicare administrator under President George W. Bush, suspects many patients want Medicare to pay for the procedure, even when it's cosmetic.
"Is most of this legitimate? No. I think probably 80 percent of it is bogus," Scully said.
A small percentage of patients, like Shirley Rafferty, do need it. Before having the procedure, 40 percent of her vision was blocked by her drooping eyelids.
"I could see my eyelashes. It was like a gray area toward the top of my vision," she said.
Fechner acknowledges that an aging population, advertising and dramatic before and after photos are helping fuel demand for eyelid lifts.
"Plastic surgery, through many avenues, has really come out of the closet. So patients feel more comfortable considering a procedure," he said.
The surgeons billing for eyelid lifts are located across the country. Many of the highest billings are in Florida.
As for the federal agency that is supposed to monitor Medicare spending -- the Centers for Medicare and Medicaid Services -- a spokesman there declined to comment when asked if agency officials had noticed a dramatic uptick in eyelid lifts or had taken any measures to ensure the millions in charges were legitimate.