Nebraska officials began raising the alarm after noticing a suspicious spike in billings to Medicare for urinary catheters, which a federal agency since has labeled a fraud scheme.
Medicare, the public insurer that covers most healthcare costs for Americans aged over 65, was billed for intermittent urinary catheters in the names of around 450 000 patients last year, compared with 40 000 in a normal year. Most of the bills came from seven small device making companies that had recently changed ownership and had no history of making catheters.
Questions are being asked about how swiftly the Centers for Medicare and Medicaid Services (CMS) spotted the spike in billing, and how much of the roughly $2bn that was billed was paid out. The agency has declined to give a figure or officially to confirm that an investigation has been opened.
The unusual billing patterns began to draw attention last summer from observant patients, who receive Medicare statements even though they are not charged, and from the National Association of Accountable Care Organizations (NAACOS). …