Staggering Rise in Catheter Bills Suggests Medicare Scam

Linda Hennis was checking her Medicare statement in January when she noticed something strange: It said a company she had never heard of had been paid about $12,000 for sending her 2,000 urinary catheters.

But she had never needed, or received, any catheters.

Hennis, a retired nurse who lives in a suburb of Chicago, noticed that the company selling the plastic tubes was called Pretty in Pink Boutique, and it was based in Texas. “There’s a mistake here,” Hennis recalled thinking.

She is among more than 450,000 Medicare beneficiaries whose accounts were billed for urinary catheters in 2023, up from about 50,000 in previous years, according to a new report produced by the National Association of Accountable Care Organizations, an advocacy group that represents hundreds of health care systems across the country.

The massive uptick in billing for catheters included $2 billion charged by seven high-volume suppliers, potentially accounting for nearly one-fifth of all Medicare spending on medical supplies in 2023. Doctors, state insurance departments and health care groups around the country said the spike in claims for catheters that were never delivered suggested a far-reaching Medicare scam.

Dara Corrigan, who runs Medicare’s Center for Program Integrity, declined to say whether the agency was investigating the catheter billings. When the federal government suspects fraud, she said, it sometimes holds payments in escrow while it reviews the claims. But she would not say whether that had happened for any of the catheter payments.

“We’re doing all this behind the scenes to ensure the integrity of the investigation,” Corrigan said, speaking generally about the agency’s process.

Many of the seven companies that the vast majority of the suspicious claims came from share executives, according to public documents and the advocacy group’s report. Only one of the businesses had a working phone number, and it did not return a request for comment. The other numbers were disconnected, went to different businesses or, in one case, went to a previous owner.

It’s unclear how the catheter companies obtained the Medicare accounts of so many people, but some had previously received phone calls asking them for their Medicare identification number. Others said they had not received any calls but suspected their names were obtained through data breaches.

This article originally appeared in The New York Times .