Trump administration questions vascular care provided by surgeons, cardiologists and radiologists

U.S. physicians may be regularly performing medically unnecessary peripheral vascular procedures in office-based labs (OBLs), according to a recent investigation from the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS). The report recommends paying closer attention to billing for peripheral vascular procedures going forward and following up on each individual case to learn more.

Why is the government focused on peripheral vascular procedures?

The government has long feared that the costs associated with performing peripheral vascular procedures—angioplasty and stenting, for example—are much too high. In fact, the U.S. Centers for Medicare and Medicaid Services (CMS) put policies in place in 2008 that incentivized performing these procedures in OBLs as a way to keep costs down. 

In the years since those policies were made, however, there have been repeated signs that physicians are now going out of their way to perform peripheral vascular procedures that are not medically unnecessary in OBLs. After peripheral vascular procedures were associated with more than $1 billion in Medicare Part B payments in 2022 alone, HHS wanted to take a closer look at billing trends for the year 2023.

Key takeaways from the report

Overall, Medicare paid physicians approximately $548 million for performing peripheral vascular procedures in an OBL setting in 2023. Now, looking closer at these cases, OIG believes approximately 19% ($105 million) of those procedures may have been medically unnecessary. These potentially fraudulent payments went to a total of 139 physicians—7% of the total pool, by the government’s count—representing the fields of vascular surgery, cardiology, interventional cardiology and interventional radiology. 

The report identified questionable procedures using four different measures:

• Physicians billing a tibial procedure for at least 95%of Medicare patients
• Physicians billing an above-average number of peripheral vascular procedures per Medicare patient
• Physicians regularly billing for more complex peripheral vascular procedures per surgical session
• Physicians billing a high percentage of patients with early-stage PAD.

“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.