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,” Ms. Corrigan said, speaking generally about the agency’s process. She described Medicare billing scams as “one of these problems that is ever-present and ever frustrating.”
Pretty in Pink Boutique, which billed Medicare at least $267 million for catheters between October 2022 and December 2023, could not be reached by phone.
Medicare billing scams can have wide-reaching consequences. Even if patients do not pay the bills themselves, more spending by the government insurance program can increase the premiums paid by enrollees in the future.
Catheters and other medical supplies are frequent targets of billing schemes. Last April, the federal government brought criminal charges against 18 defendants who had submitted bills for nonexistent coronavirus tests and other pandemic-related services. And in 2019, the Department of Justice said it had broken up an international fraud ring involving more than $1 billion in phony billing for back and knee braces.
Medical supply companies are easy to set up and have a relatively low bar for proving medical necessity. The companies “don’t need much to show why grandma needs a urinary catheter,” said Eva Gunasekera, who previously led health care fraud investigations at the Department of Justice.
Patients and doctors who have been reporting mysterious catheter claims to Medicare for months say they are frustrated by a lack of communication from the government about whether billions of dollars have been lost to an ongoing billing scam.