Medical societies respond after Trump administration questioned necessity of certain procedures
The Society for Cardiovascular Angiography and Interventions (SCAI) and four other U.S. medical societies are pushing back on certain aspects of a recent investigation by the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services.
The OIG’s report, published in early May, suggested dozens of physicians may be performing medically unnecessary procedures in the name of profit.
Now, SCAI, the Association of Black Cardiologists, the Society of Interventional Radiology, the Society for Vascular Surgeons and the Outpatient Endovascular and Interventional Society have released a new joint statement detailing their perspective on the government’s findings.
“We share OIG's commitment to the appropriate use of Medicare resources and to ensuring that patients with PAD receive care that is both medically necessary and consistent with established clinical evidence,” the groups wrote. “At the same time, we believe several aspects of the report's methodology and clinical framing merit careful consideration.”
What was in the OIG report?
According to the OIG report, a significant number of physicians are performing medically unnecessary peripheral vascular procedures—angioplasty and stenting, for example—in an office-based setting on patients with low-risk peripheral artery disease (PAD) so they can then bill Medicare and receive the reimbursement. In total, 139 vascular surgeons, cardiologists, interventional cardiologists and interventional radiologists performed vascular procedures that caught the federal government’s attention. Medicare was billed approximately $105 million to cover these procedures.
No official allegations were included in that report, but OIG representatives did suggest they would be studying each case more closely in the future.
“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,” according to the report.
U.S. medical societies respond
The five groups emphasized that certain actions being categorized as concerning by the federal government are in fact recommended by leading medical societies. Recent guidelines from the American College of Cardiology and American Heart Association, for example, gave tibial revascularization a Class I recommendation when treating patients with chronic limb-threatening ischemia (CLTI).
“A claims-based analysis that does not adjust for this distinction may identify specialized limb-salvage practices as outliers even when their care is entirely guideline-concordant,” the groups wrote. “We are concerned that certain characterizations in the report do not fully reflect this distinction and, in some instances, may not accurately represent the sources cited.”
Another key takeaway from the joint statement is that some practices specifically focus on treating CLTI, diabetic foot disease and other related conditions due to the limited number of options available to most patients. While these facilities may have “utilization patterns that differ from general PAD practices,” that is not necessarily proof of any wrongdoing.
“We would encourage any targeted review to incorporate clinical context, including indication-level analysis, before drawing conclusions about individual physicians,” the groups wrote.
The five societies did write that they “do not defend billing practices that are inconsistent with guideline-concordant, medically necessary care.” In addition, they said they look forward to working with the government going forward to protect the long-term integrity of both patient care and the Medicare program.
Click here to read the joint statement in full.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.