New Nerve Test, a Moneymaker, Divides Doctors (New York Times)
Any test which doctors provide themselves (self-referral) is an opportunity for fraud. To identify suspect cases, measure the number of tests per 1,000 patients for doctors performing the test themselves, compared to those who refer patients to another provider. You may need to make adjustments for patient diagnosis or health status.
Of course looking to evidence is most important. Are these doctors qualified to perform the service? Is the diagnostic test effective as a screening tool or should its uses be more limited? Does the test result in more treatment? Is the treatment effective?
Here are some highlights from an article from the New York Times about a product with high fraud potential:
“‘NC-stat is a Billable Procedure,’ says one slide in a Neurometrix marketing DVD obtained by The New York Times.
A worksheet prepared by one former Neurometrix salesman, labeled “CONFIDENTIAL OPPORTUNITY,” showed how a doctor could realize an annual profit of $46,588.80 by testing 10 patients a week.
‘The doctor’s making margin, the company’s making money,’ said the former salesman, who shared the document and spoke only on condition of anonymity.
For physicians, who might be able to bill only $80 or so for a routine 30-minute office visit, Neurometrix’s promise of a profit as high as $250 for 15 minutes, is compelling. So was a customer-referral program in which physicians could receive hundreds of dollars in free products for steering other doctors to Neurometrix.”