One of the nation's largest health insurance providers is questioning the relationship between neurosurgeons and neuromonitoring companies that track a patient's nervous system during complex operations, according to the Austin American-Statesman.
Paul Weller, executive director and senior counsel for Aetna, told the American-Statesman that the insurer has identified concerning trends associated with neuromonitoring that raise questions about medical necessity. Neuromonitoring is often used during certain procedures to prevent neurological damage. Arrangements between brain and spine surgeons and out-of-network neuromonitoring companies are coming under scrutiny for driving up medical costs and engaging in what could be considered a kickback scheme, although Aetna has stopped short of accusing providers of engaging in fraudulent behavior.
Out-of-network fraud schemes are not uncommon in other sectors of healthcare, including labs and compounding pharmacies. In October, America's Health Insurance Plans found that out-of-network charges vary tremendously, although the majority of charges are 300 percent higher than corresponding Medicare fees. States like California have seen an increase in balance billing, in which patients are billed for services not covered by their provider, an issue that has led payers and providers to clash in the past.
Concerns surrounding neuromonitoring in Texas are bolstered by an influx of companies with ties to the same individuals, some of which have doctors on their executive boards, according to the American-Statesman. George Lee, M.D., president of the American Society of Neurophysiological Monitoring, told the newspaper he was aware of certain business relationships that "may constitute a kickback," and the Texas Medical Board indicated it is reviewing the relationship between neuromonitoring companies and Texas surgeons.
For more:
- read the Austin American-Statesman article
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