More Than $100 Million Was Billed for Medically Questionable Vascular Procedures, Government Watchdog Finds

Nash Weerasekera, special to ProPublica Dozens of doctors are routinely performing risky vascular procedures in medical offices, generating tens of millions of dollars in Medicare payments for potentially unnecessary procedures, according to a federal report released earlier this month. The review, completed by the Office of the Inspector General at the Department of Health and Human Services, flagged nearly 140 doctors across the country as having “concerning” billing patterns.  The analysis parallels a 2023 ProPublica investigation that revealed how high Medicare reimbursements for office-based vascular treatments had fueled a surge of unnecessary procedures , putting patients at risk of amputation or even death. The inspector general’s study, which began in April 2024 , cited ProPublica’s reporting and broadly confirmed its findings. Millions of Americans have peripheral artery disease, a vascular disorder in which the buildup of plaque narrows arteries and blocks blood flow in the legs. While most treatments are safe , ProPublica’s investigation found that there has been widespread concern among medical experts that some doctors are overusing procedures on patients who may not need them.  The Centers for Medicare & Medicaid Services laid the foundation for the problem nearly 20 years ago, when it tried to rein in growing hospital costs by diverting certain common, minimally invasive procedures to outpatient facilities. These treatments may include the placement of stents in blood vessels or the removal of plaque with a bladed catheter, also known as an atherectomy.  But instead of saving taxpayers money, it created a boom . For years, even as researchers challenged the long-term safety and efficacy of these expensive procedures, the federal government did little to stop potential abuse.  ProPublica’s reporting chronicled the rise of the procedures after the introduction of the government’s financial incentive, along with horror stories of patients who lost their legs or died from complications . Our investigation examined years of federal Medicare claims data to identify and name the doctors who were making the most money off of these controversial procedures , and found that several of them had also racked up allegations of patient harm and even fraud . Doctors identified in our reporting objected to being portrayed as part of the problem , with some defending their use of the procedures, saying they could save the government money by preventing more serious complications down the road. ProPublica’s analysis also found that many procedures were being performed on patients with only mild disease , against best practices. Working with data journalists from the health analytics group CareSet , and in consultation with experts, we found that nearly 1 in 4 patients underwent the invasive procedure in the early stages of vascular disease, amounting to nearly 30,000 patients who may have endured procedures too soon or even unnecessarily. The inspector general’s analysis, which focused on data from 2019 through 2023, found that while overall payments for vascular procedures have decreased in recent years, the procedures have shifted from hospitals to physicians’ offices.  The report flagged $105 million, about a fifth of all office-based vascular payments in 2023, as suspicious for medically unnecessary procedures. About 140 doctors accounted for these “concerning” payments, with 26 physicians responsible for the majority of them. This small group of specialists each received about $3 million in medical payments on average, and treated more than four times the average number of Medicare patients compared with similar physicians, conducting double the average number of procedures per patient. Steak Dinners, Sales Reps and Risky Procedures: Inside the Big Business of Clogged Arteries In the “Wild West” of Outpatient Vascular Care, Doctors Can Reap Huge Payments as Patients Risk Life and Limb Thousands of Patients May Be Undergoing vascular procedures Too Soon or Unnecessarily About half of these flagged doctors, which include interventional radiologists, vascular surgeons and cardiologists, practiced in California and Texas. Since 2019, CMS has investigated and identified 15 providers who received overpayments for vascular procedures, according to the report. The agency has also initiated a “claims analysis project” to detect physicians who are excessively billing for certain procedures, including atherectomies.  The inspector general recommended that CMS monitor billing records to identify medically unnecessary procedures that pose a risk to Medicare enrollees and take appropriate actions. The inspector general also provided information on the outlier physicians to CMS and encouraged the agency to work with its program integrity team to review their billing patterns. “Although determining whether these physicians engaged in abusive or fraudulent practices was not within the scope of this study, their billing patterns warrant further scrutiny,” stated the report.  CMS agreed with the inspector general’s recommendations and said it would consider the report’s findings to determine next steps.  The post More Than $100 Million Was Billed for Medically Questionable vascular procedures, Government Watchdog Finds appeared first on ProPublica .