Saturday, 3 August 2013

Neuropathy Fraudsters Warning

Today's post from (see link below) outlines a fraud investigator's report on certain practices which many neuropathy patients will be aware of and they are claims from clinics or individual practitioners, to be able to either 'cure' your neuropathy or at least treat it effectively. Surprisingly enough, this can be the result of a collaboration between medical doctors, podiatrists, chiropractors and others and can be very persuasive. Very often they use hard sell advertising, with implied dangers if you don't take advantage of their services. It is vitally important to consult your specialist, as well as your home doctor and do as much research as possible into any clinic which is offering you expensive and long-lasting 'treatment'. It's a sad fact of life that unscrupulous operators will make money out of suffering and desperation but as long as we're aware of the risks, we'll be better able to sort out the genuine from the fraudulent.

Healthcare Fraud Shield’s Latest Article: Understanding Peripheral Neuropathy and the related FWA Schemes
Submitted by Howard Levinson, DC, CFE, AHFI

(This week’s article is from a guest writer, Dr. Howard Levinson, the Clinical Director of Fraud Investigations at Wellpoint, Inc.)
A recent trend involving collaboration between chiropractors, medical doctors and/or podiatrists has been identified in several areas of the country which involves treatment of patients who suffer from peripheral neuropathy.
The peripheral nervous system (PNS) include the nerves running from the brain and spinal cord to the rest of the body; the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin. Peripheral neuropathy occurs when nerves are damaged or destroyed and can’t send messages from the brain and spinal cord to the muscles, skin and other parts of the body.
There are many causes of peripheral neuropathy, including diabetes, infections, auto-immune diseases, exposure to toxic chemicals, chronic alcoholism, and certain medications – especially those used to treat cancer and HIV/AIDS. In some cases, the cause of a person’s peripheral neuropathy remains unknown. When nerves are damaged, numbness, pain or muscle weakness may occur.
The symptoms of PN often include:
A sensation of wearing an invisible “glove” or “sock”
Burning sensation or freezing pain down the nerves
Sharp, jabbing or electric-like pain
Extreme sensitivity to touch or inability to feel with hands feet
Difficulty maintaining balance
Inability to determine the position or where your feet are is not uncommon.
Many of the patients falling victim to this scheme suffer from diabetic related painful neuropathy. These patients are typically under the care of legitimate providers. Treatment involving drug therapy has been unsuccessful in resolving the patient’s symptoms. These patients are desperate and undergo this controversial care plan in hopes of finding relief.
There are a number of PN marketing programs targeting chiropractors with fantastic claims of income increases by treating neuropathy pain patients. Some programs recommend that the provider offer free dinner lectures at local restaurants to lure potential patients. Some of these marketing avenues include scare tactics advising patients that if they do nothing, they risk amputation.
The providers are typically an MD/DC clinic, a DC clinic, or a podiatric office. The providers use direct mail, TV, print advertising and the internet to garner patients. A typical protocol includes a nerve conduction study (NCS) at the onset of care. In some cases, the providers may use a mobile diagnostic provider for the testing. Interim nerve conduction studies are usually performed, followed by another at the end of care. The treatment procedure includes frequent (2-3 X per week) injections of an anesthetic agent, often Marcaine, into the peripheral nerves of the arms/legs. There have been instances in which patients have received over 100 dates of service. Providers submit claims for the number of nerves injected. In some cases, the providers were noted to up code the number of injections. e.g.) The records indicated 3 nerves injected, but 5 injection claims were submitted.
The patient also typically undergoes an electrical stimulation therapy with a HakoMed (Bioelectric) device, or other electrical stim therapy. Some clinics are using low level laser (cold laser) therapy also. In offices where there is no MD/DO/DPM, the chiropractor may use multiple PT modalities including manual massage, vibratory massage, manual therapy and ultrasound as well as manipulation.
The most prevalent diagnoses noted with this scheme include:
729.5 Pain in limb459.89 Other unspecified disorder of the circulatory system355.8 Mononeuritis of lower limb
64450-Introduction/Injection of Anesthetic Agent (Nerve Block) other peripheral nerve or branch95900-95905-Nerve Conduction Studies (pre-2013)95905-95913-Nerve Conduction Studies95860-95861-Needle electromyography (EMG)97032-Attended Electrical Stimulation
Few payers have a Medical Policy or Clinical Guidelines regarding the use of nerve blocks to manage PN. However, some Medicare carriers have established Local Coverage Determinations (L32565-Nerve Blocks for Peripheral Neuropathy) indicating; “The use of nerve blocks or injections for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically necessary…..These procedures are considered investigational, and are not eligible for coverage for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases.
I have not found any literature in a peer reviewed scientific journal or a position statement from any professional medical/chiropractic society that offers support or a rationale for frequent peripheral nerve blocks for peripheral neuropathy. Patient interviews have resulted in mixed responses. Some patients have found relief with a series of injections and a maintenance schedule of injections, others have not. Complications or adverse reactions to the services are not common but could include infections and a worsening of the patient’s condition.
Howard Levinson, DC, CFE, AHFIClinical Director Fraud InvestigationsWellPoint, Inc. SIU

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