I heard a story the other day about an audiologist who bills in a threatening manner. Without going into specifics, this audiologist reportedly over-bills, submitting for tests that appear unnecessary (billed for almost every patient) or redundant (fails to add clinical value). Obviously, this is a case of attempting to make investigational testing cost-effective. Is this action illegal or unethical? Does it affect other clinicians?
On occasion, insurers have asked for evaluation of the audiologist’s billing submissions that payers thought were questionable. My first thoughts were:
- How many audiologists would agree to criticize the actions of a colleague?
- These types of submissions can’t happen often, can they?
- Will criticisms result in this payer holding the field in lower respect?
- What might be other downstream results of these investigations into billing?
Every audiology code of ethics requires that all audiologists adhere to the code and participate in its enforcement. Nobody likes the“snitch” article of the code (Principle 8, Rules 8b and 8c of the AAA Code), but with a little thought, most everyone should see why it is necessary. Other professional providers who refuse to evaluate and help discipline (if necessary) their colleagues are likely acting in a manner that violates their own professional code. Their refusal to “rat out” their colleagues cannot be supported by a legitimate argument. If you don’t believe this, ask the courts. In other words, if you know this audiologist is billing like this, it’s your ethical duty to report it to your professional and/or licensing organization. (It’s also your legal duty.)
Regarding the above over-billing matter, arguments that investigational testing is not profitable have usually been made by those who choose not to do such tests—a self-fulfilling argument, many times used in order to jump to a sales pitch for hearing aids, which will increase profits. My experience would indicate that many audiologists in “sales positions” appear to do little testing beyond the basics. Not providing “best practices” to all patients is an ethical violation, and perhaps should be reported as per Rules 8b/c. It’s interesting to consider how many “professional” providers in a number of other fields make similar profit-based arguments.
There is a difference between over-billing (illegal) and failure to provide procedures that have value—tests that provide a baseline for future comparisons, contribute in a clinical manner to the patient’s complaints, or support prior test results. It would be helpful if each test were reimbursed at a reasonable rate, but that is not the essential determiner.
When asked to criticize or report colleagues, some audiologists have reluctantly done so. Many times direct communication with those involved solves the problem before it reaches “critical mass”. While we all hope these few audiologists are not typical of the whole, observation and my experience have not provided a great deal of hope for the level of understanding held by what seems to be too many making unsound audiology decisions or ignoring professional responsibilities.
feature image from close-up films