Alleged Medicare catheter billing scam could cost $2B

Medicare may be losing $2 billion as a result of a suspected fraud scheme that the National Association of Accountable Care Organizations discovered, according to a February 9 Washington Post article.

Seven medical equipment businesses had a sharp increase in Medicare claims for catheters, according to data from the National Association of ACOs. The firms went from charging 14 people for catheters to around 406,000 in only two years.

The investigation claims that catheters that patients never requested or got were billed to their insurance. The previous proprietor of one of the businesses claimed that she had never sold the goods to consumers in at least one instance. Federal investigators are looking into the purportedly false invoicing, according to three federal officials who talked to The Washington Post under anonymity.

The FBI said the publication that it was unable to confirm or deny the investigation’s existence.

The information was made public by the National Association of ACOs when a number of its member ACOs saw odd increases in catheter billing from a collection of businesses. While the firms billed for the catheters using the patients’ Medicare IDs, NAACOs did not find any indication that the patients had placed the order on their own.

The group has “never seen anything like this” on a national level, according to association president Clif Gaus, who spoke with the Washington Post.

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

According to The Washington Post, catheters are inexpensive products that might not be examined as closely as more expensive medical equipment, but when purchased in large quantities, they might be profitable for scammers.

HHS suggested in 2022 that Medicare lower its payments for catheters in order to lower the possibility of fraud.