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Utilization of Peripheral Vascular Procedures and CMS's Related Program Integrity Efforts

Announced on  | Last Modified on  | Project Number: OEI-01-24-00250
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The use of peripheral vascular procedures in the Medicare population has increased over the past decade. In 2022, Medicare paid more than $600 million for atherectomies and angioplasties with and without a stent in peripheral arteries. These minimally invasive surgeries aim to improve blood flow when arteries narrow or become blocked because of peripheral arterial disease but are recommended only after patients have tried medical and exercise therapy, and have lifestyle-limiting symptoms. In addition, CMS and whistleblower fraud investigations have identified these surgeries as vulnerable to improper payments. This work will determine trends in Medicare fee-for-service for surgeries in peripheral arteries over several years and identify paid claims that exhibit questionable characteristics. We will also describe the program integrity activities that CMS and its contractors have taken to combat fraud, waste, and abuse specific to procedures in peripheral arteries.

TIMELINE

  • April 15, 2024
    Announced
  • Today
    Office of Evaluation and Inspections In-Progress
  • Est FY2026
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Physician and Healthcare Practitioners Quality of Care
Target Groups
-
Financial Groups
Medicare B