Aging Americans worried about their droopy upper eyelids often rely on the plastic surgeon’s scalpel to turn back the hands of time. Increasingly, Medicare is footing the bill.

Yes, Medicare. The public health insurance program for people over 65 typically does not cover cosmetic surgery, but for cases in which a patient’s sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks — at a cost of millions of dollars.

As the Obama administration and Congress wrestle over how to restrain Medicare’s growing price tag, critics say program administrators should be more closely inspecting rapidly proliferating procedures like blepharoplasty to make sure taxpayers are not getting ripped off.

From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. In 2001, physicians billed taxpayers a total of $20 million for the procedure. By 2011, the price tag had quadrupled to $80 million. The number of physicians billing the surgery more than doubled.

“With this kind of management malpractice, it’s little wonder that the [Medicare] program is in such dire shape,” said Sen. Tom Coburn, R-Okla., who is also a physician. “The federal government is essentially asking people to game the system.”

Plastic surgeons say there are a number of legitimate reasons for the spike, including a tendency among the elderly to seek fixes for real medical issues they might have quietly suffered through even a decade ago. But surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals, and advertising that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicare’s requirement that peripheral vision actually be impaired.

Thomas Scully, former Medicare administrator under George W. Bush, has a blunter assessment; he doubts the jump is caused by anything other than seniors seeking younger-looking eyes. “How many seniors among your friends or family have needed eyelid surgery?” he said. “I bet a hell of a lot of them at 65 say, ‘You know what, I bet I can get Medicare to pay for this.’ And I can imagine the plastic surgeons love it. If you can go to patients and say that Medicare will pay, they will do it in much larger numbers.”

Florida surgeon bills Medicare for more than 2,200 eye surgeries a year

Surgeons who bill Medicare for large numbers of eyelid surgeries dot a map of the United States. Yet 11 of the 20 highest billers in 2008 were in Florida, which is both an elderly mecca and the country’s foremost magnet for questionable Medicare billing.

Among the top surgeons, the data show a South Florida doctor billed Medicare more than $800,000 in 2008 for about 2,200 eyelid lifts. That’s an average of six a day, including weekends. This same doctor was also a top biller in 2006 and 2007.

The Center is barred from naming the Florida surgeon. A 1979 federal court injunction blocks the Department of Health and Human Services from publicly releasing doctor’s names in conjunction with specific Medicare billing information. The Center sued HHS to obtain the Medicare data but, as a condition for obtaining it, signed an agreement not to publish the names of individual doctors, unless they agreed to discuss their billing histories. After repeated calls for comment, and a fax including the billing referenced by the Center, the Florida physician’s office assistant said he would not talk “due to prior engagements.”