Medicare spending on a subset of cardio procedures has skyrocketed and the Office of Inspector General (OIG) has taken note, apparently now on the hunt for fraudsters.
Certain minimally invasive peripheral vascular procedures, such as atherectomies and angioplasties, are meant to alleviate blockages and improve blood flow when arteries are narrowed due to peripheral arterial disease. But, as OIG explained, the procedures should not be recommended until patients are experiencing symptoms that interfere with their lifestyle, and only after patients have attempted other forms of medical and exercise therapy.
Notably, these procedures have been identified as susceptible to inappropriate billing, as OIG flagged in its recent announcement stating it will work to identify questionable claims that Medicare has paid. In 2022 alone, the government-funded healthcare program shelled out over $600 million for these procedures. When government spending rises sharply in a particular area, it’s a safe bet that some portion of the uptick is due to fraudulent or otherwise improper healthcare claims.
If past is prologue, now that OIG has announced this spending increase and called it out as a claim’s integrity vulnerability, it will likely scrutinize CMS’s claims data for these procedures. OIG may also target specific providers for audit, including providers with sharp increases in billings or otherwise high utilization rates, or providers that have previously demonstrated or been accused of suspect billing practices.
This is where whistleblowers can be valuable. If you have information about providers who have submitted questionable claims for peripheral vascular procedures paid for by Medicare or other government programs, you can dramatically streamline the government’s efforts to slow this massive spending and recover taxpayer funds paid for inappropriate claims. And anyone with information about fraud involving government-funded peripheral vascular procedures may be eligible for an award under the False Claims Act for reporting it.
If you've think you may have relevant information, reach out to us at Whistleblower Partners.
