Dozens of doctors routinely perform risky vascular procedures in medical offices, generating tens of millions of dollars in Medicare payments for potentially unnecessary procedures, a study finds. federal report released earlier this month.
The review, conducted by the Department of Health and Human Services’ Office of Inspector General, identified 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 in-office vascular treatments had fueled a wave of unnecessary proceduresexposing patients to the risk of amputation or even death. The study of the inspector general, which started in April 2024cited ProPublica reporting and largely confirmed its findings.
Millions of Americans suffer from peripheral artery disease, a vascular disorder in which plaque buildup narrows the arteries and blocks blood flow in the legs. While most treatments are safeProPublica’s investigation found that medical experts are widely concerned that some doctors are overusing the procedures on patients who may not need them.
The Centers for Medicare & Medicaid Services laid the groundwork for the problem nearly 20 years ago, when it tried to curb the growth of hospital costs by diverting some common, minimally invasive procedures to outpatient settings. These treatments can include placing stents in blood vessels or removing plaque with a blade catheter, also known as atherectomy.
But instead of saving taxpayers’ money, created a boom. For years, even though researchers have disputed long-term safety and the effectiveness of these costly procedures, the federal government has done little to stop potential abuses.
ProPublica reporting chronicles the increase in procedures after the government’s financial incentive was introduced, as well as horror stories from patients who lost their legs Or died of complications.
Our investigation examined years of federal Medicare claims data to identify and name the the doctors who made the most money from these controversial proceduresand found that several of them had also accumulated allegations of harm to the patient and even fraud. The doctors identified in our reporting objected to being presented as part of the problemwith some defending their use of these procedures, saying they could save the government money by avoiding more serious complications in the future.
ProPublica’s analysis also found that many procedures were being performed on patients with only mild diseaseagainst best practices. Working with data journalists from the Health Analytics Group Care setand in consultation with experts, we found that nearly one in four patients had undergone an invasive procedure in the early stages of vascular disease, representing nearly 30,000 patients who may have undergone a procedure too early, or even unnecessarily.
The inspector general’s analysis, which focused on data from 2019 to 2023, found that although overall payments for vascular procedures have declined in recent years, the procedures have shifted from hospitals to doctors’ offices.
The report flagged $105 million, or about one-fifth of all vascular payments made in-office in 2023, as suspect for medically unnecessary procedures. Approximately 140 doctors are responsible for these “concerning” payments, with 26 doctors 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 to similar doctors, performing twice the average number of procedures per patient.
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About half of these reported physicians, including 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 also launched a “claims analysis project” to detect doctors who overcharge 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 action. The inspector general also provided information about outlier physicians to CMS and encouraged the agency to work with its program integrity team to review their billing models. “While determining whether these physicians engaged in abusive or fraudulent practices was beyond the scope of this study, their billing patterns warrant further examination,” the report states.
CMS accepted the inspector general’s recommendations and said it would review the report’s findings to determine next steps.