WASHINGTON, D.C. — The Office of the Inspector General at the Department of Health and Human Services released a report in early May 2024 flagging nearly 140 doctors across the U.S. for having 'concerning' billing patterns related to vascular procedures. The inspector general identified $105 million in 2023 Medicare payments for office-based vascular procedures as suspicious for being medically unnecessary.

Twenty-six physicians accounted for the majority of the $105 million in flagged Medicare payments. Each of those physicians received about $3 million in Medicare payments on average in 2023. They treated more than four times the average number of Medicare patients compared with similar physicians and conducted double the average number of vascular procedures per patient.

About half of the nearly 140 flagged doctors practiced in California and Texas. The inspector general’s analysis focused on Medicare data from 2019 through 2023. Vascular procedures in question may include stent placement or atherectomy, which is the removal of plaque with a bladed catheter.

The inspector general’s report stated, '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.' The inspector general recommended that the Centers for Medicare & Medicaid Services monitor billing records to identify medically unnecessary vascular procedures that pose a risk to Medicare enrollees and take appropriate actions. It also provided information on outlier physicians to the agency and encouraged it to work with its program integrity team to review their billing patterns.

The Centers for Medicare & Medicaid Services agreed with the inspector general’s recommendations and said it would consider the report’s findings to determine next steps. The agency has already initiated a 'claims analysis project' to detect physicians who are excessively billing for certain vascular procedures, including atherectomies. Since 2019, the agency has investigated and identified 15 providers who received overpayments for vascular procedures.

The inspector general’s study cited 2023 reporting by a news organization and broadly confirmed its findings. That investigation had found that high Medicare reimbursements for office-based vascular treatments had fueled a surge of unnecessary procedures. Its analysis, conducted with CareSet and medical experts, estimated that nearly 1 in 4 patients underwent invasive vascular procedures in the early stages of vascular disease—amounting to nearly 30,000 patients who may have endured procedures too soon or unnecessarily.