Dozens of physicians are regularly carrying out risky vascular procedures in their medical offices, collecting tens of millions of dollars in Medicare payments for treatments that may not have been medically necessary, a federal report released earlier this month found. The review by the Office of the Inspector General at the Department of Health and Human Services identified nearly 140 doctors nationwide with “concerning” billing patterns. The analysis mirrors a 2023 ProPublica investigation that showed how generous Medicare payments for office-based vascular procedures had driven a wave of unnecessary interventions, exposing patients to risks of amputation or death. The inspector general’s investigation, launched in April 2024, referenced ProPublica’s reporting and largely validated its conclusions. Millions of Americans suffer from peripheral artery disease, a condition in which plaque accumulation narrows the arteries and restricts blood flow to the legs. While most treatments are safe, ProPublica’s investigation revealed significant concern among medical experts that some physicians are performing unnecessary procedures on patients who don’t actually need them. Nearly two decades ago, the Centers for Medicare & Medicaid Services laid the groundwork for this issue when it attempted to control rising hospital costs by shifting certain common, minimally invasive procedures to outpatient settings. These treatments can involve inserting stents into blood vessels or using a bladed catheter to remove plaque, a procedure known as atherectomy. But rather than saving taxpayers money, it triggered a boom. For years, despite researchers questioning the long-term safety and effectiveness of these costly procedures, the federal government did little to curb potential abuses. ProPublica’s reporting traced the surge in these treatments following the introduction of government financial incentives, along with harrowing accounts of patients who lost limbs or died from complications. Our investigation analyzed years of federal Medicare claims data to identify and name the physicians earning the most from these disputed procedures—and discovered that several had accumulated accusations of patient harm and even fraud. Doctors flagged in our investigation resisted being depicted as contributors to the issue. Some defended their use of the procedures, arguing that they could reduce long-term government costs by averting more severe complications later. ProPublica’s review also revealed that a large share of the procedures were performed on patients with only mild symptoms, contrary to established medical guidelines. In collaboration with data journalists from the health analytics firm CareSet and after consulting with experts, we discovered that nearly one in four patients received an invasive procedure during the early stages of vascular disease—totaling almost 30,000 individuals who may have undergone the intervention prematurely or even when it was unnecessary. The inspector general’s review, which examined claims from 2019 to 2023, revealed that although overall Medicare spending on vascular procedures has declined, the procedures have increasingly moved from hospitals to physicians’ offices. The report identified $105 million—roughly one-fifth of all office-based vascular payments in 2023—as potentially tied to medically unnecessary procedures. Approximately 140 doctors were responsible for these “troubling” payments, 26 of whom accounted for the vast majority.
