Annie Waldman Profile picture
Dec 12, 2023 15 tweets 6 min read Read on X
NEW: Dr. Caitlin Hicks and fellow researchers warned that some doctors appeared to be overusing lucrative vascular procedures, needlessly exposing patients to risk of harm.

For her research, she was accused of "fratricide" and called a "nazi."

My latest: propublica.org/article/resear…
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ProPublica has spent the past year investigating vascular procedures, and we've chronicled horror story after horror story of patients who lost their legs from complications after lucrative procedures. propublica.org/series/arteria…
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We found that some doctors are making **millions of dollars** doing a questionable number of procedures, often in outpatient clinics, exposing patients to risks of harm, including amputation and even death. propublica.org/article/maryla…
In our reporting, one treatment has stood out:
Atherectomy procedures, which use catheters affixed with lasers or blades to pulverize plaque from vessel walls. Image
Even though research has indicated that atherectomies may not be more effective than other treatments – and experts warn they may be associated with a higher risk of complications – they remain unchecked because doing them remains easy and profitable propublica.org/article/resear…
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We analyzed five years of public Medicare data, and found that a small group of doctors is responsible for a majority of atherectomy procedures and payments:

About 200 doctors earned nearly *$1.5 billion* in reimbursement for almost 200,000 procedures. propublica.org/article/thousa…
CMS, the agency that oversees Medicare, told ProPublica that it examines its billing data for outliers, taking action when it identifies problems by denying claims, suspending payments or referring questionable providers to law enforcement. Image
We wanted to understand more about how patients are being treated, so we worked with @CareSet data journos @FredTrotter + Alma Trotter to examine how often doctors are conducting vascular procedures on patients with more mild vascular disease: propublica.org/article/thousa…
While experts recognize atherectomies can be appropriate for severe disease, experts told us that most patients with milder symptoms like leg pain while walking, a condition known as claudication, should start with treatments like medication and exercise. propublica.org/article/what-t…
When we examined the data, we found that **thousands** of patients may be undergoing procedures in the earliest stages of vascular disease, possibly too soon or unnecessarily propublica.org/article/thousa…
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Doctors named in the data objected to being portrayed as part of the problem. Several rebuffed our analysis, which relied on Medicare claims data and does not have complete clinical info on patient symptoms or disease severity. Image
You can read more about about the limitations of the data and our analysis in our methodology: propublica.org/article/how-pr…
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Even with data limitations, experts said that these kinds of outlier analyses are crucial to protecting patients.

"Most of the public is flying blind," said Johns Hopkins surgeon and researcher Dr. Marty Makary. propublica.org/article/thousa…
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We're continuing to report on this and want to hear from patients, doctors, experts and whistleblowers. DM or email at annie.waldman@propublica.org, or fill our our form: propublica.org/getinvolved/pe…
And another special shout out to our stellar data partners @CareSet @FredTrotter and Alma Trotter. Learn more about their work here: careset.com

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More from @AnnieWaldman

Dec 13, 2024
After reviewing leaked documents, we have found UnitedHealth is strategically limiting access to a treatment for thousands of children with autism across the country in order to cut costs.

Advocates say the company’s strategy may be illegal.



👇propublica.org/article/united…
We have obtained what is effectively the company’s strategic playbook for limiting access to a type of therapy for kids with autism.

Through its Optum subsidiary, is "pursuing market-specific action plans” and "optimization efforts" to limit children’s access to the treatment. Image
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While acknowledging some areas have “very long waitlists,” the company said it aims to “prevent new providers from joining the network” and “terminate” existing ones, including “cost outliers.” ​​

In some states, this reduction could impact up to 19% of its children in therapy. Image
Read 16 tweets
Aug 25, 2024
America is in the midst of a mental health crisis. But finding a therapist who takes insurance can feel impossible.

Insurers say that’s because there aren’t enough therapists.

We found that's not entirely true.

Here's why you can't find a therapist🧵👇projects.propublica.org/why-i-left-the…
We heard from 500+ mental health providers: therapists, social workers, psychologists and psychiatrists.

Many spent years studying and honing their skills. They opened mental health practices and joined insurance networks to treat people who couldn’t afford to pay out of pocket.

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What we heard from them was surprising:

Quietly, and with minimal pushback from regulators, health insurers have assumed an outsize role in mental health care.

It is often insurers, not therapists, that determine who can get treatment, what kind they can get and for how long. Image
Read 13 tweets
May 24, 2023
NEW: Years ago, researchers warned the fed govt that some doctors may be overusing certain medical procedures so egregiously, they may be a "threat to public safety."

We looked into it, and found doctors making millions as patients risked life and limb: propublica.org/article/maryla…
The procedures in question are used to treat a common medical condition: clogged leg vessels (also known as peripheral arterial disease), which impacts more than 6.5 million Americans. Image
The federal govt kicked off the problem 15 years ago, when it tried to rein in the swelling hospital costs for vascular care.

It turbocharged payments to doctors’ offices, but instead of saving money, it started a boom. Image
Read 11 tweets
Feb 16, 2023
NEW: About one month ago, we received an anonymous tip:

"PLEASE look into what happened at the Robert J Dole VA…hundreds of local military heroes had their legs mutilated…and nobody has been held accountable."

And so I started to dig….a thread:
propublica.org/article/medtro…
Back in 2017, a whistleblower lawsuit made some disturbing claims:

VA hospital workers in Kansas allegedly received kickbacks from a medical device company, whose sales reps then “groomed and trained” doctors to excessively use their devices in patients, putting them at risk.
These were devices used to treat a common medical condition: clogged leg vessels (also known as peripheral artery disease), which impacts more than 6 million Americans over the age of 40.
Read 19 tweets
Mar 10, 2022
NEW: When we first heard that Louisiana had quietly opened up a new lockup for teens, where they were shackled, held in solitary w/ no education, we almost didn't believe it. The reality was so much worse.

A collab w/ @schwartzapfel + @erinleinhorn + me
propublica.org/article/shackl…
@schwartzapfel @erinleinhorn Last year, as Louisiana was scrambling to respond to a wave of violence and escapes at juvenile facilities, state officials quietly opened up a high-security lockup for the most troubled teens in their care
We found teens were locked in solitary confinement for 23, sometimes 24 hours a day. When they were let out for showers, their legs and hands were shackled. They received no education for months.
Read 11 tweets
Jul 30, 2018
Update: Lawmakers have introduced legislation requiring the @usedgov to publicly disclose which schools have been accused of civil rights violations as well as any corrective actions or other resolutions of its probes: propublica.org/article/devos-…
The proposed bill follows @ProPublica’s reporting that found Secretary of Education DeVos has scuttled +1200 civil rights probes that were opened under Obama: propublica.org/article/devos-…
Our data analysis also found that the Trump admin is less likely than its predecessor to find wrongdoing by school districts on issues ranging from racial & sexual harassment to meeting the needs of disabled students:
Read 5 tweets

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