Dozens of doctors routinely perform dangerous vascular procedures in their offices, resulting in tens of millions of dollars in Medicare payments for potentially unnecessary procedures, according to a federal report released earlier this month.
The investigation, completed by the Department of Health and Human Services’ Office of Inspector General, flagged approximately 140 physicians across the country for “concerning” billing patterns.
This analysis parallels a 2023 ProPublica investigation that revealed how high Medicare reimbursement for in-office vascular treatments fuels a proliferation of unnecessary procedures and puts patients at risk of amputations and death. The inspector general’s investigation, which began in April 2024, cited the ProPublica report and broadly corroborated its findings.
Millions of Americans have peripheral artery disease. Peripheral artery disease is a blood vessel disorder in which plaque buildup narrows the arteries and blocks blood flow to the legs. Although most treatments are safe, a ProPublica investigation found widespread concern among medical professionals that some doctors are overusing them on patients who don’t need them.
The Centers for Medicare and Medicaid Services laid the groundwork for this problem nearly 20 years ago, when it sought to curb rising hospital costs by diverting certain common, minimally invasive procedures to outpatient facilities. These treatments may include placing stents in blood vessels or removing plaque using a bladed catheter, also known as atherectomy.
But instead of saving taxpayers money, it created a boom. For years, researchers have challenged the long-term safety and effectiveness of these expensive procedures, yet the federal government has done little to prevent potential abuse.
A ProPublica report chronicles the rise in surgeries after government financial incentives were introduced, along with horror stories of patients losing limbs or dying from complications.
Our investigation examined years of federal Medicare claims data to identify and name the doctors who made the most money from these controversial procedures, and found that several of them also racked up allegations of patient harm and even fraud. Doctors identified in our report objected to being considered part of the problem, with some defending the use of the procedure, saying it would save the government money by preventing more serious complications in the future.
ProPublica’s analysis also found that many procedures were performed on patients with mild symptoms, contrary to best practices. In collaboration with data journalists from health analytics group CareSet and in consultation with experts, we found that nearly one in four patients received an invasive procedure in the early stages of their vascular disease, nearly 30,000, and the procedure may have been premature or unnecessary.
The inspector general’s analysis, which focused on data from 2019 to 2023, found that while total payments for vascular procedures have declined in recent years, procedures are moving from hospitals to clinics.
The report flagged $105 million in 2023, about one-fifth of the office’s vascular costs, as suspected medically unnecessary procedures. Approximately 140 physicians covered these “related” payments, with 26 physicians paying the majority. This small group of specialists each received an average of approximately $3 million in medical fees, treated an average of four times more Medicare patients than similar physicians, and performed twice the average number of surgeries per patient.
Approximately half of the physicians receiving these reports, including interventional radiologists, vascular surgeons, and cardiologists, practice in California and Texas.
Since 2019, CMS has investigated and identified 15 health care providers that received overpayments for vascular procedures, according to the report. The agency also launched a Billing Analysis Project to detect doctors who are overcharging for certain procedures, including atherectomy.
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 encouraged CMS to provide information on outlier physicians and work with the Program Integrity Team to review billing patterns. “While it is beyond the scope of this study to determine whether these physicians engaged in abusive or fraudulent practices, their billing patterns warrant further scrutiny,” the report states.
CMS agreed with the Inspector General’s recommendations and said it would consider the report’s findings to determine next steps.
