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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
Completed
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

REPORT PUBLISHED

Utilization Trends and Medicare Part B Billing for Office-Based Peripheral Vascular Procedures Raise Questions About Program Integrity (OEI-01-24-00250)

From 2019 through 2023:

  • While the overall rate and Medicare Part B payment for peripheral vascular procedures decreased, physicians’ use of these procedures shifted from hospital outpatient departments to OBLs.

In 2023:

  • Despite routine use of atherectomy and tibial artery procedures being controversial due to potential complication risks and poor outcomes, physicians used these procedures often in OBLs (75 percent and 47 percent of procedures, respectively).
  • Of payments made to physicians for peripheral vascular procedures performed in OBLs, $105 million may indicate billing for medically unnecessary procedures.
  • 26 OBL physicians accounted for 61 percent of the concerning payments we identified.

26-E-01-021.01 to CMS - Open Unimplemented
Update expected on 11/03/2026
CMS should Monitor billing to identify peripheral vascular procedures that may be medically unnecessary, which may indicate fraud, waste, or abuse.

26-E-01-021.02 to CMS - Open Unimplemented
Update expected on 11/03/2026
CMS should Follow up on the physicians OIG identified with concerning billing for peripheral vascular procedures.

View in Recommendation Tracker
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