It appears that some investigators have done the leg work to put together winning cases regarding vestibular fraud. I commend them, and I hope it has some effect on those currently committing fraud. In the past, I have posted about Profit Centers for Primary Care regarding using VNG testing solely for cash production.
I start with an excerpt from a webpage managed by Dr. Evan Levine, a Cardiologist in New York City. He relates a familiar scene involving a recent conversation:
“… Carmine told me he had “some type of test at my doctor where I looked at blinking lights.” To me it sounded like a study called Videonystagmography; better known as a VNG exam. This test is supposed to be used to look for reasons why a patient has recurrent dizziness but seems to be ordered by some physicians as a means of improving their bottom line.
“Did you complain of feeling dizzy, Carmine,” I asked? “No, but the doctor said, ‘Don’t worry about it your insurance will pay for it.’” Recently I had a chance to walk into that doctor’s office and noticed he had a room full of “Don’t worry about it your insurance will pay for it” testing devices. What is the ultimate insult to me is that this doctor is flourishing under the current healthcare system while qualified and honest physicians are paying for their colleague’s dishonesty.
This type of practice has been going on for years, and I suspect still represents a large portion of Medicare money spent on vestibular testing. But, some fraudsters have been taken down recently. The Houston Chronicle filed a story a couple of weeks ago about a Dr. Augustine Egbunike, who along with his associates, was found guilty in a $3 million dollar scheme based mostly around vestibular testing. Egbunke got 57 months in prison and must pay back $2 million.
A review of the indictment of Dr. Egbunike’s associates revealed some bold tactics. This is just a fraction of the charges. Over less than 3 months, they billed 416 vestibular tests on the same patient. On a different patient, they billed 614 tests over 51 different dates. The tests were not even being interpreted by anyone at the clinic. They were being sent off site to Florida for interpretation by a physician that never even met the patient.
In another case, Terri Schneider, an Audiologist in Florida, was sentenced to 94 months in prison and ordered to repay $2.5 million on charges largely related to vestibular fraud. Schneider and her co-conspirators sent in false claims totaling over $12 million.
The convictions may or may not deter future fraud associated with vestibular testing. There are still manufacturers and distributors giving incorrect billing information in hopes ( I assume) of selling more equipment. There does not appear to be any plan in place to protect patients and legitimate practitioners for the consequences of these fraudulent schemes. Patients still have a hard time getting in to a qualified vestibular practitioner, and those practitioners are struggling to keep their vestibular labs solvent.