At-home urinary catheters are at the center of a possible $2 billion Medicare fraud scheme — reportedly the largest in the program’s history.
Seven companies allegedly operating out of Connecticut, Florida, Kentucky, New York and Texas submitted fraudulent insurance claims for the catheters, according to a news report in The Washington Post. Over two years, the companies went from billing 14 patients to nearly 406,000 patients for catheters, which, because they are low-cost products, reportedly can fly under the radar of regulators. The Federal Bureau of Investigation’s public affairs office could not confirm or deny the existence of the investigation, while Centers for Medicare & Medicaid Services officials also would not discuss the allegations, the news outlet said.
The National Association of ACOs (NAACOS) uncovered the scheme, the news outlet reported. Members of NAACOS found that the companies submitted a slew of bills to Medicare across the last two years for intermittent urinary catheters, and there was no evidence the patients wanted the catheters or even received them. All seven of the companies had been accredited with Medicare, though the accreditation itself was dubious, being linked to a person who said they no longer worked at the company and had sold it last year.
While in 2021, the companies submitted catheter bills for only 14 patients, in 2023, the seven companies billed Medicare about $1.9 billion for catheters for nearly 406,000 patients, NAACOS said. An analysis conducted recently by Aledade, a network of independent primary care providers, also revealed that urinary catheter claims across 1 million patients spiked by more than 1,600% between early 2022 and late 2023 and was linked to the same seven companies.
Many patients and businesses have been caught in the crosshairs of the scheme. Pretty in Pink Boutique in Franklin, TN, which provides accessories for cancer patients, for example, has received dozens of complaints from Medicare recipients who claimed the boutique charged their health insurance companies thousands of dollars for catheters never ordered, The Washington Post reported.