This story was originally published by ProPublica.
A new analysis of Medicare claims by ProPublica and CareSet found that atherectomies, a procedure to treat vascular disease, were performed on about 30,000 patients who had questionable need for them.
They handed the federal agency a list of outlier physicians they found in the government insurer’s own data. But the agency has done little to stop the practice and instead continues to pay doctors who exhibit this behavior millions of dollars a year.
The names of the doctors were never publicly revealed.
ProPublica is shedding new light on the problem.
Their cases and many others, plus dozens of interviews with patients, health care providers and medical device representatives, have laid bare a thriving industry of strip-mall clinics and outpatient vascular centers where elderly patients are being exploited for multimillion-dollar Medicare payouts.
As part of the procedure, doctors use a laser or bladed catheter to remove plaque from the patients’ vessel walls. For treatments conducted in outpatient clinics, Medicare pays generous reimbursements to doctors, who can charge tens of thousands of dollars for procedures done in a single visit. Experts recognize atherectomies are appropriate for
severe vascular disease, but they
told ProPublica that the majority of patients with milder symptoms like leg pain while walking, a condition known as claudication, should
start with treatments like medication and exercise.
We analyzed Medicare claims records for people who had first-time atherectomies between 2019 and 2022 and found that nearly 1 in 4 patients underwent the invasive procedure after only a diagnosis for claudication, indicating an early stage of vascular disease.
Some doctors stood out because of the money they made. Dr. Amiel Moshfegh, a Beverly Hills radiologist, received $45 million from Medicare over five years for performing thousands of atherectomies, according to
public Medicare records. Most of his Medicare
patients were older Latinos, according to federal data, who were warned in Spanish-language advertisements that poor circulation could lead to amputation. About 15% of his patients who underwent a first-time atherectomy, 170 of them, appeared to have milder disease based on their diagnosis for claudication, according to the data.
Other doctors stood out because a large portion of their patients who underwent atherectomies had just claudication, raising questions about the necessity of the procedures. That was the case for Dr. Christopher LeCroy, who works for a chain of vascular clinics across the Florida panhandle; about half of his first-time atherectomy patients appeared to have milder disease based on their diagnosis, according to the data.
And while over 5,000 physicians who provide vascular care rarely intervened on patients who appeared to have milder vascular disease based on their diagnoses, ProPublica and CareSet found that about 170 other doctors performed half or more of their first-time atherectomies on these kinds of patients.
“It’s concerning that we may be doing unnecessary procedures and spending unnecessary health care dollars,” said Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine and a leading researcher on procedure overuse. “We know that aggressive interventions for claudication may give short-term relief, but in the long term, patients are the same as they started or even worse.”
Doctors named in our data objected to being portrayed as part of the problem.
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Data analysis by Alma Trotter and Fred Trotter (CareSet)
