How to do high volumes of outrageously inappropriate surgery on healthy patients and get away with it:
The Scam: Diagnose Glaucoma and do multiple SLT lasers or other lasers,
because “who’s gonna find out”. It's easy to scare a patient with the prospect of glaucoma:
- Your nerves are "cupped"
- There is an early field change, but we caught it in time if we act now
- You have low tension glaucoma
- Falsify the pressure readings
- If we don't treat you, you'll be blind in "x" months.
- This would never respond to eye drops.
- Once treated and the eye that was normal all along looks, well, "normal", claim cure and head to the bank.
The Scam: If patient is over 40, “Oh, you have a cataract. We need to get that
out of there.” Technically, it is true that there is a “cataract” in that by 40,
EVERY lens has some early “nuclear sclerosis”. This is what causes
“presbyopia”, which is the need for reading glasses, but it doesn’t require
surgery for years if not decades. Another way to trick the patient and falsify the record is to alter the "Brightness Acuity Tester, which is basically a penlight shining into a cup with a pinhole through which the patient looks at an eye chart. To create glare that "documents" the cataract, simply alter the direction of the light to shine too directly at the patient.
In any case, the patient is told all of this with great sincerity, and many go along, like lambs to the slaughter. Cataract surgery is quick, and even if unnecessary usually results in good vision. To add insult to injury, the patient is often talked into a “premium” bifocal lens implant
that costs 1500 (honest charge) to 3000 (inflated charge) extra PER EYE, in
OUT OF POCKET expense to the patient.
The Scam: The patient comes in with a new floater from vitreous syneresis and/
or a harmless vitreous detachment. They are examined, often receiving utterly
unindicated testing such as visual fields, fluorescein angiography, gonioscopy
for hundreds or thousands of dollars, and then told that they have a retinal tear.
Laser is applied to a peripheral area, ablating this supposed small tear and in
so doing creating a scar that “destroys the evidence”. What is really treated is
either nothing or a harmless retinal tag, which are common and insignificant.
Diabetic Macular Edema
The Scam: The patient has diabetes. That’s it. That is all that is needed. They
are told that they have edema or neovascularization (which in truth can be
asymptomatic, but so is the lack of trouble, so how would the patient know?)
They are then told that this will blind them without therapy. They often receive
extensive testing which they don’t need and for which they are charged well
over appropriate rates and then receive sham laser to harmless diabetic
changes (or to nothing at all), and of course once they “heal” everything is okay
because it was okay to start with.
The VEGF Two Step
There are are a number of severe bioethical issues surrounding the area of retinal pharmacotherapy. These have been covered elsewhere on this site. There are important and troubling inherent incentives to use Lucentis and other expensive pharmacologics in spite of the fact that there is no demonstrable benefit in using them as first line treatment. There is the 6% profit that Medicare pays which adds up handsomely for expensive and unnecessarily frequent treatments. There is the literally millions of airline miles that doctors can rack up paying for treatments on credit cards. There is the "rebate" program, in which Genentech pays doctors up to $40,000 per quarter to use Lucentis over Avastin. If patients were paid, it might be called a rebate. As currently administrated, it is a kickback.
There is another particularly heinous scam that has been uncovered where a very few doctors may have taken advantage of the obvious fact that Lucentis and Avastin are virtually interchangeable: Simply interchange them. Buy Lucentis but don't use it. Treat patients with Avastin, telling them and the payer that you used Lucentis. Receive the inflated reimbursement for Lucentis, and then sell the Lucentis that was never used overseas. Like the other scams listed here, this scam takes advantage of the trust placed in physicians, violating that trust with a "whose going to find out?" attitude.
The scam: No matter what the patient has, they often receive
myriad tests that they don’t need, often including invasive tests such as
fluorescein angiography, for which they are charged inflated rates. They are
told that they need these tests, just as legitimate doctors do for patients that
really do need them. How is the patient to know? They trust their doctor. The
difference here is that eventually many patients catch on, go elsewhere, and
then find that they have been scammed.