Hi, Over the years I’ve filled roles for regulating fraud, waste and abuse in Medicare, and the list of culprits is exhaustive, but one we’re going to talk about today is Hyperbaric Oxygen Therapy (HBO), in short, it’s a big waste of money and time, and doesn’t prevent amputations. Shut it down. Don’t make American tax payers pay for it.
Hyperbaric Oxygen Therapy (HBOT) has indeed been a major focus for federal investigators due to high rates of non-compliance and conflicting data regarding its clinical efficacy for common conditions like diabetic foot ulcers. Fraud and Waste Data
- High Non-Compliance Rates: A 2018 audit by the HHS Office of Inspector General (OIG) found that 85% of sampled outpatient HBOT claims did not comply with Medicare requirements, leading to an estimated $42.6 million in overpayments for a single contractor alone.
- Major Settlements: In 2018, Healogics Inc., the nations largest wound care provider, agreed to pay up to $22.51 million to settle False Claims Act allegations that it knowingly billed Medicare for medically unnecessary HBOT.
- Strict Billing Controls: Due to high error rates and suspected overuse, CMS implemented prior authorization requirements for non-emergency HBOT in several states (Illinois, Michigan, and New Jersey) where spending was significantly above the national average.
Clinical Efficacy and Amputations
- Negative Large-Scale Findings: A major longitudinal study of over 6,000 patients found that HBOT did not improve wound healing or prevent amputations in patients defined by CMS eligibility criteria. In fact, those receiving HBOT were statistically more likely to have an amputation in that specific cohort.
- Conflicting Evidence: Some smaller studies or those focused on specific subgroups (like patients with Peripheral Arterial Occlusive Disease) suggest a reduction in major amputation rates. However, systemic reviews often conclude there is insufficient evidence to support routine use for diabetic foot ulcers.
- Cost vs. Benefit: While the cost per 40-treatment series has decreased to roughly $23,834, critics argue the lack of proven benefit for many patients makes even these lower costs a significant source of waste.