Alleged Medicare catheter billing scam could cost $2B

An alleged fraud scheme uncovered by the National Association of Accountable Care Organizations could be costing Medicare $2 billion, The Washington Post reported Feb. 9. 

Data from the National Association of ACOs recorded a massive spike in Medicare claims for catheters among seven medical equipment companies. In two years, the companies went from billing 14 patients for catheters to nearly 406,000. 

According to the report, patients' insurers were billed for catheters that they never ordered or received. In at least one case, the former owner of one of the companies said it wasn't a product she ever offered to customers. Three federal officials who spoke to The Washington Post anonymously confirmed federal officials are investigating the alleged fraudulent billing. The FBI told the outlet it could not confirm or deny the existence of an investigation. 

The National Association of ACOs uncovered the data after several member ACOs discovered unusual spikes in billing for catheters from a group of companies. NAACOs found no evidence patients ordered the catheters on their own, though the companies used their Medicare numbers to bill for them. 

Clif Gaus, president of the association, told the Washington Post the association has "never seen anything like this" on a national scale. 

"Where do you get half a million [Medicare] beneficiary names and ID numbers?" Dr. Gaus told the outlet. "There has to be a breach somewhere in the healthcare system." 

Because catheters are low-cost items, they may not receive as much scrutiny as pricier medical devices, according to The Washington Post, but when ordered in bulk they could create profit for fraudsters. 

In 2022, HHS recommended Medicare reduce the reimbursements it pays for catheters to reduce the risk of fraud. 

Read more here. 

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