Fraud in Vestibular and Balance Testing

Fraud in Vestibular and Balance Testing - Fraud in...

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Fraud in Vestibular and Balance Testing By Timothy Hain ENG testing -- A group of persons have discovered that Medicare does not closely scrutinize billing for ENG testing. These people have performed phony vestibular tests, and provided superficially plausible reports, that actually have little or no content. Another way that unscrupulous people found to manipulate the system was to use the "'vertical electrode" code for ENG testing. This code was meant to be used only one time per ENG, but these people used it multiple instances for the same patient. Because this trick is still used in some parts of the country, a clue that an ENG may be fraudulent is that it is done with electrodes rather than VENG, as for this situation the vertical electrode fraudulent code can be used. In general, one should suspect fraud when a written report is produced without any underlying data. Common situations where this happens is in ENG testing and ECochG testing. For ENG testing many think the reason that honest clinicians omit detail is that a proper ENG report is many pages long. In ECochG testing, we think that the reason is that ECochG's are hard to do and there is sometimes shyness about presenting noisy or questionable traces to public scrutiny. Nevertheless, it seems to us that without underlying data, there is no proof that the test was performed, as well as no method of ascertaining that the quality was adequate, and thus billing could reasonably be denied. Here, there seem to be many "holes" in the system - ENG's are being ordered/done by people who are not delivering medical care. The quality of the ENG equipment is sometimes very questionable, and finally there are many loopholes in the billing process. There are several ways to solve this problem -- our thought is that these measures would be effective: 1. ENG's should be only "billable" if a physician with otology training requests one. There should be an indication for the ENG. In other words, ENG's could be ordered by the individuals involved in the present abuse patterns -- including chiropractors, primary care doctors, PTs and "stand alone" audiologists. 2. A laboratory certification procedure should be in place (see item 4), and ENG's should not be billable without certification. 3. The loopholes in the billing procedures should be closed. Fraudulent rotatory chair testing Another method found by unscrupulous groups to "game" the Medicare billing system was to bill repeatedly (on the same day) for "sweeps" of active head movement testing, using commercial active head movement testing systems such as the "Vorteq" and "VAT". While there is some
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value to these tests, they are not as useful as a "real" rotatory chair and also do not require anywhere near the same investment of space and equipment as the "real system". Our suggestions:
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This note was uploaded on 04/11/2010 for the course AUD 831 taught by Professor Drlisakoch during the Spring '10 term at A.T. Still University.

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Fraud in Vestibular and Balance Testing - Fraud in...

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