How CareSet Data Helped Expose $100M+ in Questionable Medicare Vascular Billing
By CareSet Staff Writer
A federal watchdog has confirmed what CareSet’s Medicare data analytics helped uncover years earlier: Medicare paid millions for peripheral vascular procedures that may have been medically unnecessary, with a small group of physicians responsible for a disproportionate share of the billing.
In 2023, a ProPublica investigation using CareSet’s analysis of Medicare claims data found that nearly one in four patients who underwent a first-time atherectomy between 2019 and 2022 received the procedure despite having only mild vascular disease. The findings showed that roughly 30,000 Medicare beneficiaries may have undergone invasive treatment before it was clinically warranted.
Those findings were broadly validated in a May 2026 report from the Department of Health and Human Services Office of Inspector General, which cited CareSet and ProPublica’s work. The report identified $105 million in suspicious Medicare payments, about one-fifth of all office-based peripheral vascular procedure reimbursements in 2023, and flagged 139 physicians with concerning billing patterns.
Just 26 doctors accounted for most of the questionable payments, each averaging roughly $3 million in Medicare reimbursements while performing procedures at more than twice the typical rate.
The problem traces back nearly two decades, when CMS shifted certain invasive procedures from hospitals to outpatient settings in an effort to reduce costs. Instead, the payment change created incentives that contributed to rapid growth in procedures such as atherectomies even as researchers raised concerns about their safety and effectiveness.
Analysis by CareSet’s Alma Trotter and Fred Trotter helped ProPublica identify the physicians who were making the most money off of the procedures, several of whom had accumulated allegations of patient harm and, in some cases, fraud.
According to the OIG’s May report, CMS has identified 15 providers for overpayments since 2019. The agency has also launched a claims-monitoring initiative to detect excessive vascular billing and agreed to implement the inspector general’s recommendations, including monitoring billing patterns and reviewing physicians flagged by the OIG for concerning billing practices.
