The Trump Administration Is Right To Take On Duplicate Medicare Payments

This week’s elections made clear that Americans are concerned about affordability, including the rising cost of health care. Voter research found that healthcare costs were a major concern in the midterms.

The Trump administration took a good step this week when Dr. Mehmet Oz and the Centers for Medicare & Medicaid Services (CMS) finalized a rule addressing payments that can pay physicians twice for the same work.

Here is the issue: When a doctor performs a procedure, Medicare’s payment includes routine care related to it. The doctor can also bill Medicare for a separate evaluation on the same day, but only if it involves significant care beyond what is normally included in the procedure.

That distinction matters because the procedure payment already covers routine work, such as examining the patient before the procedure and checking on them afterward. If Medicare pays again for the same work as a separate visit, it is paying twice.

Consider a patient who sees an eye doctor for an injection. Deciding to give the injection is part of the procedure. If the doctor bills that decision as a separate visit, without providing significant additional care, Medicare can pay twice for the same work.

Doctors can also provide significant additional care that justifies a separate visit. Even in those cases, CMS says, the payments for the visit and the procedure can overlap.

The new Medicare rule addresses that potential overlap. Starting in 2027, when a doctor provides a qualifying office visit and certain procedures on the same day, Medicare will pay the highest-priced service in full. It will pay 80 percent of the usual amount for the other qualifying visits or procedures —saving 20 percent.

CMS originally proposed a 50 percent reduction and wanted to cover more procedures. After considering public comments, the agency narrowed the rule and reduced the adjustment to 20 percent.

A 2025 inspector general audit shows why this issue deserves attention. From June 2022 through May 2023, Medicare paid $313 million for 3.3 million eye injections and another $124 million for 1.4 million separately billed visits on the same day. Doctors billed for a separate visit alongside 42 percent of the injections.

The inspector general reviewed 24 of those visit claims. In 22 cases, the records did not support billing for a separate visit. The inspector general recommended that CMS review the claims and recover any improper payments, potentially up to $124 million.

A separate review of dermatology billing found that doctors met Medicare’s requirements in 90 of 100 sampled claims. Even so, the inspector general estimated $62.9 million in overpayments.

These audits do not tell us how much overlap exists when visits are properly billed, or whether 20 percent is the right adjustment. They do show why Medicare should examine these payments closely and recover payments that were not justified – because taxpayers were paying twice for the same service.

Physicians deserve fair compensation for their time, skill, and judgment. Taxpayers and beneficiaries deserve payment policies that reflect the resources actually required to provide care.

The Trump administration deserves credit for taking a practical step toward making health care more affordable. Changes to billing rules rarely make headlines, but they matter: reducing unnecessary payments can help protect patients from paying more than they should for care and, across the health care system, help ease the cost pressures that drive premiums, taxes and out-of-pocket costs.

This rule alone will not solve the affordability problem, but it is a good step. Small changes like this can add up when applied across millions of visits and combined with other efforts to reduce unnecessary costs. Over time, those improvements can help ease the pressure on families and taxpayers.

CMS should monitor the results of this change, refine the policy where the evidence warrants, and continue looking for ways to make health care more affordable.

James Carter is a former deputy assistant secretary of the U.S. Treasury. Later, he served as the Senate Budget Committee’s chief economist.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.

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