Written by TAC Staff: Yellow Pages
Saturday, 28 February 2004 00:00
Allstate Seeks $3.5M in Fraud Lawsuit
CALIFORNIA: In early January, Allstate Insurance Company and Allstate Indemnity Company began serving summons and complaints upon a Los Angeles County chiropractor and his wife, accusing them of taking part in schemes designed to defraud the companies.
Paul Yan, DC, Winnie Yan and Paul Yan Chiropractic Corporation are accused of reportedly operating a scheme of excessive billing, fraudulent billing and billing for services that were never rendered. The lawsuit alleges that more than 150 false or inflated claims were submitted to Allstate by Yan for patient services including examinations, diagnostic testing and treatment. According to the complaint, filed in Los Angeles Superior Court, most of the patients had been involved in minor car accidents and suffered from minor soft tissue injuries.
Allstate is seeking more than $3.5 million under a California law passed to help combat insurance fraud. Five years ago, Allstate Insurance Company filed the first lawsuit under the 1995 state law designed to augment law enforcement's efforts to prosecute defrauders and in 2001 won an $8.2 million jury award. Allstate has filed a number of similar lawsuits under this statute, emphasizing its zero tolerance for insurance fraud.
No charges have yet been filed against Yan, his wife or the chiropractic firm, according to officials.
DC Acquitted in Tax Evasion Case
FLORIDA: A Florida chiropractor beat the IRS this week when a federal judge in Orlando threw out an income tax evasion case against her.
It was the second time in 11 years that Dr. Lois Somerville defeated a case against her for lack of evidence.
The victory came in early December when a U.S. District Judge issued a judgment of acquittal before the case went to the jury.
In September, Somerville had been charged in a federal indictment with evading taxes from 1990 through 1998. If convicted, she would have faced up to five years in prison and $1.25 million in fines.
Prosecutors with the tax division of the U.S. Department of Justice claimed Somerville concealed her true earnings from the IRS by depositing most of her income into two trusts she created in 1990 “in an effort to keep her personal residence out of the reach of an Internal Revenue Service tax lien,” according to the indictment.
But, there’s more! In 1992, the chiropractor served as her own lawyer when the state District Court of Appeal ruled that state insurance investigators illegally seized her patient, billing and bank records.
The raid followed a nine-month investigation of her practice that produced eight counts of business fraud and one count of organized fraud. State prosecutors dropped the case, saying they could not proceed without the seized records.
And, yet, more! Unrelated charges of grand theft and forgery in a separate case against Somerville were dropped in 1992 when prosecutors said they had witness problems.
Insurers Seek $17 Million from NJ Chiropractors
NEW JERSEY: Allstate New Jersey Insurance Company and Encompass Insurance have filed a multi-million dollar civil complaint, under the New Jersey Insurance Fraud Prevention Act against Scott Greenberg, DC, a Central New Jersey-based chiropractor and Middlesex Diagnostic Associates, a neurological testing company, as well as a medical billing business, Accurate Billing Company, Inc., which he allegedly controls. Other defendants in the suit include Roman Sorin, MD, and Neuro Muscular Medical Group, PA, alleged to be controlled by Sorin, as well as Steven Brownstein, MD, and Brunswick Imaging Corporation, an MRI facility alleged to be controlled by Brownstein. The companies are seeking recovery of more than $17 million they have paid to the various defendants beginning in 1993.
They’re also asking for treble damages, and a declaratory judgment against the practitioners “in order to halt all claims being made by Drs. Greenberg, Brownstein and Sorin and the professional entities controlled by them.” That request was included because the companies are still receiving claims from the defendants.
Greenberg allegedly orchestrated a referral scheme to defraud the carriers. Specifically, he’s accused of illegally self-referring his chiropractic patients to Middlesex, a mobile diagnostic facility in which he was the sole owner, which is illegal under NJ law. Greenberg is also charged with setting up and controlling Accurate Billing Company, which kept 30 percent of Neuro Muscular Group’s monthly gross income. The lawsuit contends that the deal was a kickback from Sorin to Greenberg in exchange for the patient referrals.
Jury Acquits DC of Sex Assault Charges
PENNSYLVANIA: A jury in Delaware County recently acquitted a Dr. Len Finkel of charges that he sexually assaulted a former employee and patient.
The allegations stemmed from a July 15, 2002 ultrasound treatment that Finkel gave to a female patient.
During the trial, Finkel denied deliberately touching the woman's breast and rubbing against her while sexually aroused, as she had accused him of doing.
He acknowledged that he may have “inadvertently” made contact with the patient’s breast while giving her a massage. He said the woman was moving around during the massage and leaned back a few inches.
DC Sentenced for Shooting Dog
ALABAMA: A man accused of fatally shooting a 2-year-old yellow Labrador retriever last Labor Day was sentenced in early December of 2003 to 120 days in jail and fined $1,000.
Patrick James Perschke, DC, was apparently walking his three dogs on the beach when they were approached by the playful Lab, named Shiney, and one of Perschke’s dogs bit him in the ear, whereupon Shiney ran away.
According to witnesses, Perschke then took out a gun and shot the Lab four times, killing him.
In a two-hour non-jury trial, a Municipal Court Judge found Perschke guilty of animal cruelty and reckless endangerment. He was sentenced to 60 days in jail and a $500 fine for each charge, the terms to be served consecutively. A charge of carrying a pistol without a permit was dropped for technical reasons.
Perschke said he will appeal the case.
Beware the Mobile Diagnostic Units
Over the years, chiropractic attorneys from across the country have voiced concern over the practices of diagnostic testing companies. In Ohio, the Justice Department successfully obtained felony plea agreements from several DC’s who used these services. In some cases, the insurers are using state law to pursue action against chiro’s who contract with these mobile service vendors. How these cases will end up is anyone's guess. What is certain, however, is the enormous costs—both financial and emotional—to defend these actions.
Are you going to get caught in a legal quagmire when you use a mobile diagnostic lab company? Before you sign on the bottom line, hire competent legal counsel to advise you.
Keeping Abreast of Things…
IOWA: In late November of 2003, The Iowa Board of Chiropractic Examiners suspended the license of a Fort Dodge chiropractor for 60 days for allegedly improperly touching the breasts of female patients.
Dennis Musselman said he was following legitimate chiropractic procedures, but the board disagreed, saying that he failed to keep proper records to support his actions, and that he failed to ensure the dignity of his patients.
The board placed Musselman on three years’ probation, ordered him to get more education, and ruled that he must have an employee present whenever he treats women.
The board began its investigation after receiving a complaint in 2001 from a patient who also had been Musselman's employee. The woman said the chiropractor had treated her in the past, mainly for lower back pain, board documents say.
Death of Chiropractic Patient in 1996 Ruled Accidental
TORONTO, CANADA: In mid-January, the death of a factory worker who suffered a fatal stroke in 1996 after having her neck manipulated by a chiropractor was ruled as accidental and not due to natural causes.
Lana Lewis, a mother of three, died two weeks after undergoing a procedure known as a high-neck manipulation by Toronto chiropractor Philip Emanuele, who had been treating the 45-year old for migraine headaches.
The coroner's jury finding of accidental death means that “the injury that led to the stroke was as the result of trauma,” said the chief counsel for the coroner’s office.
Tim Danson, the lawyer for the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College, had argued that Lewis died of natural causes brought on by an unhealthy lifestyle.
“It represents a massive miscarriage of justice,” said Danson, who plans to appeal the decision.
Two neurologists who concluded that Lewis died of natural causes were not permitted to testify, he noted.
Written by TAC Staff: Yellow Pages
Tuesday, 30 September 2003 00:00
Chiropractic Physician Sues Insurance Giant and Gets Verdict on Behalf of Patient
MISSOURI: Dr. Anthony W. Calandro, a Crestwood, MO, chiropractic physician, was “fed up” with insurance company tactics. So, on behalf of his patient, he a Mr. Mitch Jacobs, attorney-at-law with over fifteen years of trial experience, filed a lawsuit against Safeco Automobile Insurance Co.
The suit claims Safeco cheated the patient out of benefits, which had been rightfully bought. Safeco allegedly uses a common tactic called “consultant review” where a so-called “doctor” reviews a file without ever seeing the injured patient, thereby rendering a bogus cut in benefits, thus cheating patients out of the benefits which they paid for to cover their health care costs.
The trial lasted over two hours, and two days later the verdict was in favor of Dr. Calandro. The judgment award was for over $4000, which included the amount denied, interest, and all attorney and court costs.
Dr. Calandro recommends that other doctors and patients faced with this tactic stand up for their rights and prove that, when paying high premiums for benefits, they should be rightfully reimbursed accordingly, to insure good health care.
Lawmakers Vote to Limit Physical Therapy and Chiropractic Care
CALIFORNIA: In the final day of the state legislature’s regular session, California legislators voted to make revisions to their state’s worker’s compensation insurance system, with the intent of reducing premiums and overall costs associated with the system.
Along with provisions regarding prescription drugs, fee schedules and fraud-related fine caps, the legislature also approved provisions that will limit chiropractic and physical therapy treatment for injured employees to no more than 24 treatments per claim. In addition, the legislature also voted to stop the state’s vocational rehabilitation program in favor of educational grants for retraining injured employees.
If signed into the law, the new worker’s compensation provisions will also establish medical guidelines for governing how injuries are treated and allow for an administrative review of previous worker’s compensation cases to prevent future over-treatment.
While these cost-saving measures may help ease the pains of the states’s worker’s compensation program for the worker with an injury resulting from an ergonomics-related issue, it may also cut into the effectiveness and viability of some of the more popular current forms of injury treatment, including chiropractic care and physical therapy.
With the highest premiums in the US, California’s worker’s compensation system has come under fire by insurance providers, businesses and lawmakers. The state’s governor, Grey Davis, has vowed to sign the recently approved workers compensation reform package into law.
Sacramento Bee: Insurance Journal
Chance Parker, Grandson of Dr. Jim Parker,
Dies at Age 38
TEXAS: Michael Chance Parker (age 38), affectionately known as Chance, grandson of the founder of Parker College, Dr. James W. Parker, and son of seminar leader and Past-President of Parker College, Dr. W. Karl Parker, passed away at his home in Burleson, TX, July 31, 2003.
Parker discovered he had renal cell carcinoma when his right kidney failed in 1997. About a year later, he discovered it had metastasized to the bones in his right arm, followed by his left arm, his neck, sacrum and pelvis and, later, to his adrenal and lungs. He was originally given a death sentence of about six months from the onset of the disease, but with the help of natural health care, chiropractic and prayer, he remarkably survived an additional six years.
Parker was well known and loved by many in the profession, as he was a staff member of the Parker Seminars and Share International for many years, moving up the ranks until he was promoted to be president of the forty-year-old Parker Products company.
He is survived by over twenty-five members of the Parker family including seven chiropractors, his father, brothers and uncles.
“Chance really had a knack of making friends with everyone,” his father, Dr. Karl Parker said of him. “His positive uplifting attitude was never dampened by his condition and the pain he was suffering, even up to the very end. He was a model for many others in loving life, family and friends, regardless of life’s circumstances.”
Parker passed away peacefully with his father, mother, wife, children and numerous friends at his side. A memorial was held at his church, Crestmont Baptist in Burleson, which was filled with family and friends. His life’s pride and joy were his wife, Diane, and two children, Jordan (10) and Cole (8). Parker requested no flowers and that any gifts be sent to a fund he established to help with his children’s education. Send to Diane Parker at 2360 Charles Ave, Burleson, TX, 76028.
Medicare Announces Plan to Accept HIPAA Non-Compliant Electronic Transactions After the Compliance Deadline
WASHINGTON: The Centers for Medicare & Medicaid Services (CMS) has announced that it will soften up on its October 16, 2003, deadline with a contingency plan designed to accept noncompliant electronic transactions submitted after that deadline has passed. This will ensure continued processing of claims from thousands of providers who are unable to meet the deadline and would have had their Medicare claims rejected were it not for this late-hour reprieve.
“Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance, while not disrupting providers’ cash flow and operations,” CMS Administrator Tom Scully states, ”so that beneficiaries can continue to get the health care services they need.”
CMS came to this decision after reviewing statistics showing unacceptably low numbers of compliant claims being submitted.
“Non-doctors” Excluded from $540 Million Dollar CIGNA Settlement
FLORIDA: A federal judge gave preliminary approval, in early September, to an agreement requiring Cigna Corp. to spend $540 million to settle claims that the insurance company chronically skimped on payments to the nation’s 700,000 doctors.
Cigna joins Aetna in settling racketeering lawsuits against managed care industry leaders. Both companies have agreed to pay refunds to doctors and change procedures for reviewing and processing doctors’ claims for services.Cigna agreed to spend $400 million on internal changes, at least $70 million to doctors on claims up to 12 years old, $55 million on attorneys’ fees and $15 million to create a health care foundation.
Doctors expect to see $300 million in savings, mostly on overhead for handling claims and appeals.
Chiropractors, podiatrists, optometrists, therapists, mental health counselors and others were excluded from the agreement and will not be able to recover money for claims that were improperly denied or services for which they were shortchanged, lawyers on the case said.
“We’re pursuing separate litigation,” said Alan H. Rolnick, a Miami attorney who is among several attorneys seeking to gain a court victory or a settlement for health-care providers not covered by the pact reached with physicians. Those lawyers told Moreno they hope to negotiate with Cigna, but neither side would suggest a date for a status conference.
The lawsuit upon which the “non-doctors” are building is a case which was filed early this year by Allen Knecht, a Portland, OR, chiropractor. The suit was transferred to Moreno because he has been designated to handle all similar class actions.
Rolnick said his team does not know the number of health professionals who would fit into the class, and that lawyers are “trying to determine that now.” When Moreno proposed negotiations between the two sides, Cigna lawyers said they didn’t anticipate any immediately because they are trying to put final touches on the physicians’ settlement.
Quackpot Barrett Crushed in Federal Court—Again...
CALIFORNIA: Some people never learn. Stephen Barrett (quackwatch.com) seems to be one of those.
Despite loss after loss, and humiliation on top of humiliation, self styled “quackbuster,” Stephen Barrett trudges on to the next embarrassment.
Like a bug in the fast lane, Barrett is doomed to be wiped off the windshield of the North American Health Freedom Movement time after time, it appears.
This time, Barrett, apparently stung from defeats in other arenas, and perhaps trying to reclaim some dignity from a world becoming accustomed to laughing at his anti-health antics, sued the attorney he’s come to associate with his steady downfall in the politics of health care, Carlos Negrete.
It’s not clear what the subject of Barrett’s suit against Negrete in Federal Court in San Diego was all about. Barrett submits volumes of whiney material in his court actions, none of which, seems to be acquainted with reality. But, what is known is that Barrett used, as his own attorney, one Morse Mehrban, listed as the general counsel of the National Council Against Health Fraud (NCAHF). It was Mehrban who was quoted in the LA Law Journal as saying, “I consider suicide daily.”
Negrete flattened them both—without breaking a sweat. Another victory for GOOD, in the battle against EVIL.
Of course, Barrett also sued, in the same lawsuit, world-renowned health-humanitarian Hulda Regehr Clark PhD, ND. Barrett can’t seem to talk, or write, these days, without bringing up Clark’s name in some way. So, it’s not surprising he put Clark’s name in the lawsuit. He describes her as an “Unlicensed Naturopath, Hulda Clark,” in his writing. His hatred and resentment of her accomplishments, compared to his, are obvious. He lost to Clark, too.…
Barrett had to allegedly “retire” from the medical profession, giving up his license in 1993, when he was in his mid-50’s. He admits that he didn’t have enough medical practice income in 1993 to even pay the required malpractice insurance premiums. Barrett, who claims to be a retired psychiatrist, was forced to admit in court documents (forced by Negrete) that he only had nine patients all year, each year, for several years, before he supposedly “retired.” Psychiatrists get their patients from referrals from other MD’s. Doctors in the LeHigh Valley of Pennsylvania just weren’t sending him any business. Anybody wonder why?
And now Barrett is failing as a “quackbuster.”
By the way—Barrett lost in an anti-SLAPP motion, which means he gets to pay Negrete, and Clark’s, attorney fees.…
Tim Bolen—Consumer Advocate website
FLORIDA: The Florida Office of Insurance Regulation (OIR) is moving ahead with developing guidelines designed to tighten personal injury protection (PIP) rules in the state, and the National Association of Independent Insurers (NAII) expressed confidence that the reforms will help combat fraud in that state.
“The industry, the department and medical representatives are working to formulate a list of excluded tests that everyone can agree on,” said James S. Taylor, southeastern regional manager for the NAII.
The State Board of Medicine held a workshop recently to discuss excluded diagnostic procedures, with insurance industry and medical associations in attendance. Insurers agreed that a number of tests should no longer be covered by PIP, including procedures on a list created by New Jersey in its auto reform efforts. Such tests include diagnostic spinal ultrasound, nerve conduction velocity tests, reflexology and digital range of motion studies.
After receiving input from medical associations and the Board of Chiropractic Medicine, the State Board of Medicine found that the groups see no medical necessity or value for many common PIP diagnostic tests.
In other action, the Office of Insurance Regulation has developed a revised PIP sworn disclosure form that requires a signature from patients stating that they have actually received the medical services being claimed.
”Although the details are still being developed, we are confident that these methods will help reduce the problem of PIP fraud in Florida,” Taylor noted.
Pass on the information to warn other D.C.’s about events that are really happening to chiropractors. When you see a “ yellow page” article in your local, regional, or national newspaper about chiropractic or a fellow chiropractor, fax, e-mail or mail it to us at TAC. For further information, fax: 1-305-716-9212 or see page 4 for our mailing address.
Written by TAC Staff: Yellow Pages
Wednesday, 30 July 2003 00:00
Allstate, Liberty Mutual File $1M Lawsuit in Alleged Fraud Scam
KENTUCKY: June 26, 2003, Allstate Insurance Company and Liberty Mutual Group announced they jointly filed a federal RICO lawsuit against a Kentucky doctor and owners of several medical clinics and billing companies in that state.
The lawsuit seeks a declaration in regard to reimbursement of more than $1 million dollars for payments issued on behalf of policyholders by Allstate and Liberty Mutual Group companies, including Liberty Mutual Insurance Company, Employers Insurance of Wausau and Indiana Insurance Company.
Allstate and Liberty Mutual allege that the defendants formed and operated several medical clinics and billing companies in which excessive and unnecessary MRI’s and nerve tests were ordered. The suit contends that the defendants billed for those excessive medical tests and for services not rendered. The lawsuit also alleges the clinics and several mobile diagnostic operations established illegal fee-splitting agreements. The suit currently involves more than 900 Allstate personal injury protection claims, and 300 Liberty Mutual, Wausau and Indiana claims for personal injury protection, workers’ compensation and bodily injury.
Chiropractor Penalized for Narcotics Problems
ILLINOIS: An investigation of a Rockford weight-loss clinic has come to a close, several years after the state accused the clinic of improperly buying and distributing narcotics for profit.
David Girgenti, a chiropractor, settled the case with the state in February. His chiropractic license was revoked for 45 days, from Feb. 20 to April 6. He was placed on a 30-month probation through Sept. 6, 2005. He also was fined $15,000.
Girgenti allegedly “did not properly supervise his staff in the purchase of medicine and supplies for the clinic,” according to the settlement. Seven doctors employed by Girgenti were also disciplined.
Girgenti said his employees were responsible for the narcotics troubles.
“I was on the tail end of this,” he said. “There were very specific protocols they were to follow for the ordering and storing of drugs. They didn’t follow protocol.”
Chiropractor Pleads Guilty in Patient-death Case
PENNSYLVANIA: Joanne M. Gallagher, DC, who practiced for close to 20 years in Hazleton, PA, was convicted of insurance fraud in connection with the death of a 30-year-old epileptic woman whom she treated with cranial therapy. Court documents indicated that the patient died of severe seizures after she followed Gallagher’s advice to stop taking her anticonvulsive medication. The fraud involved submitting insurance claims falsely describing “meningeal balancing” as spinal manipulation. After learning that her fatal advice had been tape-recorded, Gallagher pled guilty to one count of mail fraud under an agreement that she surrender her chiropractic license in 45 days and agree not to resume practice unless cleared to do so by a federal court judge. Sentencing is expected to take place in September. The crime carries a maximum sentence of 5 years in prison and a $250,000 fine.
Animal Rights Group Harassing Palmer Colleges
FLORIDA: Bea Arthur, the star of “Golden Girls” and “Maude,” has joined an animal rights organization in criticizing Palmer Chiropractic University System’s animal research.
The actress recently left taped telephone messages for dozens of employees at three Palmer campuses. She claimed that the Davenport, Iowa-based Palmer “mutilates” cats and asked its employees to oppose the school’s chiropractic research, according to the Associated Press. She made the calls on behalf of People for the Ethical Treatment of Animals.
PETA’s Web site urges supporters to contact Palmer officials. Employees at Palmer College of Chiropractic Florida said PETA’s campaign has led to dozens of “abusive” letters, e-mail messages and phone calls, the AP reports.
“It’s outrageous. (PETA) encourages people to call and harass us,” Palmer spokesman Randy Heuston said. “They have placed their philosophy of animal rights above medical, chiropractic health care progress.”
Are you sure that new patient isn’t part of a “sting” operation?
TEXAS: A Jasper, Texas, chiropractor is facing felony charges following an undercover “sting” operation conducted by Texas Mutual Insurance Company. On July 15, 2003, a Travis County grand jury indicted Dr. Michael T. Fleck, owner of East Texas Chiropractic, on insurance fraud-related charges.
Investigators affiliated with the Texas Mutual Insurance Co. began reviewing Dr. Fleck’s billing practices after learning that he had taken several patients off work after other doctors had already released them to return to work. In some cases, Dr. Fleck allegedly refused to return patients to work even when they said they were pain-free and able to return to work. The investigation also revealed that Dr. Fleck allegedly charged unusually large amounts for so-called “aquatic therapy.”
A workers’ compensation specialist assisted the investigators by posing as an injured worker. Dr. Fleck treated him for several weeks, and the investigators documented it, minute by minute. Later, the investigators contrasted the treatment Dr. Fleck delivered with the bills he submitted for the treatment. Their findings allege that Dr. Fleck fraudulently billed Texas Mutual Insurance Company for services not rendered and for services to which he was not entitled payment.
The Fleck investigation is part of Texas Mutual’s “Zero Tolerance for Fraud” program. Texas Mutual maintains three teams of fraud investigators permanently assigned to investigate every report of suspected fraud.
Life and CCE Bury the Hatchet!?
GEORGIA: Life University, the nation’s largest chiropractic school, graduated about 300 students on Sunday, June 15, u u2003, a year after the Council on Chiropractic Education pulled the university’s accreditation, reports The Atlanta Journal and Constitution.
After the university learned it would take a minimum of two years to restore its credentials, the school sued the Council for more than $100 million in damages. A federal court restored Life’s accreditation in February until the lawsuit could be resolved, an order which the CCE appealed.
But, wait! Life and the CCE have buried the hatchet. An official news release issued jointly by the two entities states that Life’s current accredited status will remain in effect and provides for a special accreditation process that is scheduled to be completed by the University by the end of January 2005.
D’Youville College to Offer Chiropractic Program
New York: In what many consider a ground breaking move in healthcare education, D’Youville College has announced it will be offering a Doctor of Chiropractic program beginning in 2004.
D’Youville will be the first standard accredited multi-disciplinary college in New York State to “mainstream” chiropractic education by offering the Doctor of Chiropractic degree and only the second college in the country to do so. (The University of Bridgeport in Connecticut started their program in 1990.) Canada, a major source of students for D’Youville, has only one school of chiropractic.
The State Education Department approved the program in June and D’Youville is now actively recruiting freshmen students.
Previously, students interested in the chiropractic profession had to attend one of 16 single purpose institutions nationwide primarily dedicated to chiropractic education. Now, with D’Youville entering the field, a student will take liberal arts and science courses required for an undergraduate degree with students from other health-related disciplines and then embark on professional level evidence-based chiropractic studies.
U.S. House of Representatives Demands Veterans Affairs Department Hire DC’s
VIRGINIA: The House of Representatives has formally ordered the Department of Veterans Affairs to speed up the implementation of chiropractic services into the veterans health care system—a requirement that was passed into law in 1999 but has since been delayed by bureaucratic foot dragging. The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) strongly supported the measure and have been working closely with a bipartisan coalition of key legislators to ensure its passage.
The bill, known as the “Veterans Health Care Improvement Act (HR 2357),” was passed by voice vote on Monday, July 21. Championed by Rep. Jerry Moran (R-KS) and Rep. Rob Simmons (R-CT), Chairman of the Veterans’ Affairs Subcommittee on Health, it contains a provision instructing the VA to hire and employ doctors of chiropractic. Legislation passed in 1999 (P.L. 106-117) required the VA to develop a plan for offering chiropractic care, but the new bill goes a step further and eliminates the remaining bureaucratic obstacles that have prevented the formal establishment of chiropractic clinical care in the VA.
Chiropractor Sentenced to Five Years in Prison for Fraud
FLORIDA: A chiropractor that once ran for City Council will spend more than five years in prison for his part in a million-dollar health care fraud scheme.
Russell Posner was sentenced in late June to 63 months in prison. He must pay $782,188 in restitution and undergo mental health and substance abuse evaluation and treatment.
He pleaded guilty in February to making false claims to Medicare, conspiring to defraud the Social Security Administration and racketeering.
“He basically plead to protect his family from having to go through a trial,” Posner’s attorney said. “He has young kids, and he wanted to minimize the harm to them.”
For years, Posner headed a storefront office on Pine Island Road, posing as a $6-an-hour clerk too arthritic to work as a chiropractor, prosecutors have said.
In reality, prosecutors said, he wrote prescriptions, passed out pills, and helped others mastermind ways to cheat public and private insurance companies with phony claims.
South Florida Sun-Sentinel. Distributed by Knight Ridder/Tribune Business News.
WV Chiropractors Lead Country in Worker’s Compensation Payments
WEST VIRGINIA: State lawmakers are working to maintain funding for the worker’s compensation system—and chiropractors should be rooting for them all the way.
Chiropractors who live in southern West Virginia make more from worker’s compensation payments than their colleagues in other parts of the country, according to the Charleston Gazette-Mail. And if the state legislature cuts back on the system, that could mean a sizeable pay decrease for chiropractors.
Overall, physicians of all specialties from the South made more from worker’s compensation payments than their counterparts elsewhere. Most of the 20 individual physicians who received payments between 1998 and 2002 that ranged from $857,598 to approximately $2.6 million came from southern counties.
Ten of the top dozen chiropractic centers for worker’s compensation reimbursements were located in or around the West Virginia counties of Nicholas, Mercer and Wayne. Four chiropractic clinics received more than $2 million during the past five years.
Chiro Wire TAC
Written by TAC Staff: Yellow Pages
Friday, 30 May 2003 00:00
The Passing of a Revolutionary Diet Doctor
NEW YORK: On Tuesday, April 8, Dr. Robert C. Atkins slipped on an icy sidewalk outside his Manhattan office and suffered a head injury. After undergoing emergency brain surgery at Cornell University Medical Center in New York City, he remained in a coma until his death on April 17. At age 72, Dr. Atkins still worked full time, attending to patients and overseeing the Atkins Center for Complementary Medicine.
Jenny Thompson, a spokesperson for Health Sciences Institute, commented following the death, saying, “HSI has worked closely with Dr. Atkins in the past, and so his death was both a great personal and professional loss. Most of the news stories I read described him as a diet “guru,” and, in the sense that he was an influential, groundbreaking leader in the field of complementary medicine, he was indeed something of a guru—a trusted counselor who helped millions of people regain their physical health with his unconventional ideas about nutrition.”
After many years of abuse by mainstream nutritionists, there was a sea change for Dr. Atkins and the Atkins diet last summer, illustrated by a cover story in the Sunday New York Times Magazine, which showed how a steadily growing minority of establishment researchers were beginning to take seriously the low-carbohydrate diet made famous by the author of Dr. Atkins’ Diet Revolution.
Over the course of 30 years, Dr. Atkins never wavered from his controversial dietary ideas. In a nutshell, the Atkins plan advises us to eat as much meat and other high protein and high fat foods as we care to, while avoiding starches and refined carbohydrates such as breads, pasta, rice, and sugars. This plan has won many millions of readers worldwide, but has drawn numerous, often passionate attacks from the nutrition and diet establishment.
The American Heart Association has long condemned the Atkins diet as an unhealthy regimen for the cardiovascular system. So it must have been thoroughly galling to many in the AHA “low-fat” camp when the results of a Duke University study were announced last November, as part of the 75th annual AHA meeting. In all of the heart health categories in that trial, the Atkins diet scored equal or higher marks than the AHA’s “Step 1” low-fat diet.
This was a major victory for Dr. Atkins—to be vindicated with prestigious research, and to have it announced in the camp of his most vocal detracters.
Health Sciences Institute www.hsbaltimore.com
Traveling Chiropractor Accused of Practicing without License
FLORIDA: A doctor and his wife who travelled the country performing what investigators said was an unusual form of therapy were arrested last month, accused of practicing without a license in Florida.
The Brevard County Sheriff’s Office charged Dr. Dean Howell and his wife, Trisha Howell, of Tonasket, WA, with practicing naturopathy, massage therapy and chiropractic medicine without a license after arresting them at an acupuncturist’s office in Cocoa, FL.
According to Howell’s Web site, the procedure, known as neurocranial restructuring, or NCR, involves a combination of deep muscle massage and the brief insertion of inflatable balloons into a patient’s nose and throat to return the body to its natural shape. The site says the procedure can help ailments ranging from Alzheimer’s disease to wrinkles within four days.
Howell was licensed in the state of Washington, though that license was suspended in 1989 for five years, said Karen Newell, an investigative technician with the Sheriff’s Office.
Newell said an insurance company tipped the Orlando Health Department that Howell was not licensed in Florida. A schedule on Howell’s Web site indicated that he would be in Cocoa Beach between May 8-11.
The Howells have been released on bonds and are scheduled to appear in court in early June.
State Licensing Boards Can’t Get Quorums to Work
GEORGIA: Several state licensing boards were forced to call off their May meetings because they couldn’t get enough people to make a quorum.
The Georgia Board of Chiropractic Examiners only had one member on its six-person board. The meeting was canceled for lack of a quorum.
Three other state professional licensing boards—for dispensing opticians, for licensed dietitians and for private detectives and security agencies—called off their meetings for the same reason, reported The Atlanta Journal-Constitution..
Five other boards were also left without quorums after the state Senate refused, on the last day of the legislative session, to confirm members that then-Gov. Roy Barnes had appointed since the previous General Assembly.
The situation has thrown professionals all over the state into turmoil as they wait to receive licenses or have their licenses renewed, the Atlanta newspaper reported. Consumers who have filed complaints also have to wait, because such disciplinary actions as a fine or expulsion cannot be taken without a vote by the licensing board.
The Senate confirmed only forty of the 210 appointments Barnes made to boards, commissions and authorities.
Clermont Physician Cleared of Malpractice
FLORIDA: A six-member jury last month dismissed claims that Clermont chiropractor Kenneth Felt acted irresponsibly in caring for an elderly patient who broke her right hip.
Marguerite Leggett, 74, filed a civil complaint against Felt and Clermont Chiropractic in October 2001 claiming Felt should have prevented her from falling onto the floor during an examination.
Felt had asked Leggett, during a Sept. 23, 1999, examination to turn onto her back during a spinal manipulation treatment. Leggett, who was lying on her stomach, reportedly put her right leg on the floor in attempting to stand to shift her position when her leg gave way and she fell to the floor.
The fall broke her hip. She has had to have three hip surgeries since the fall, her attorney Linda Schwichtenberg of Orlando said.
A half dozen experts testified during the three-day civil trial trying to determine the exact cause and time of the hip fracture and whether Felt acted properly during the examination.
Pembroke chiropractor Donald Woeltjen, who testified for Felt, said examiners do not normally help patients shift their position in order to avoid hurting them.
He also said getting off a 22-inch exam table is not a difficult task requiring additional assistance.
“Getting off that table is not different than getting out of bed,” he said.
Felt’s attorney, Kurt Spengler of Orlando, argued that Felt followed standard procedures during the examination.
Damaging Report, Highlights Chiropractic Costs
CALIFORNIA: Chiropractic costs and frequency of services have increased noticeably in California, which spells bad news for the industry.
A report released by the California Workers’ Compensation Institute (CCWI) shows a 153-percent increase in chiropractic costs from 1996 to 2001 and an increase from 59 to 120 in the average number of chiropractic procedures per claim. The study shows that though the percentage of claims involving chiropractic treatment dropped from 1993 to 2000, the amount paid for chiropractic care increased.
The report states that chiropractors are now the leading medical providers in California’s worker compensation system, news that only fuels the fire for insurers and employers pushing state lawmakers to control medical costs. Legislation already introduced in the state senate would limit chiropractic visits to fifteen per year.
Nationally Syndicated Comic Strip Highlights Chiropractic
The widely read “Broom Hilda” comic strip featured an amusing and very positive depiction of the role chiropractors play in caring for the daily health needs of people. The March 23rd edition of the comic strip showed a chiropractor’s office filled with people injured doing their spring gardening. While comic, the intention of the creator, Russell Myers, served as a reminder to millions of readers that doctors of chiropractic are there when you need them, whatever the season. To view this great positive message, visit the Broom Hilda website at http://www.comicspage.com/broomhilda/ and go to the March 23rd archive.
Court Approves $470 Million Dollar Settlement in Aetna Case
NEW YORK: On May 29, U.S. District Court Judge Federico Moreno of the Southern District of Florida preliminarily approved a settlement agreement announced earlier between Aetna and the plaintiffs representing over 700,000 physicians, state and other medical societies.
The ruling conditionally certifies a class for settlement of physicians who provided services to Aetna or any of the other defendants, allows notice to be sent out to class members informing them of the agreement and schedules a fairness hearing for October 13, 2003, whereby the judge will consider whether to finally approve the settlement presented by the plaintiffs and Aetna.
In reaction to the decision by Judge Moreno, Tim Norbeck, Executive Director of the Connecticut State Medical Society commented today: “This country’s patients and physicians alike should hail Judge Federico Moreno for his approval of the Aetna settlement with 700,000 medical doctors on terms that will favor their patients’ actual medical care over the intrusive technicalities and oppressive minutiae that have long plagued managed care systems.
“We recognize Judge Moreno for his pioneering the way by which health insurers and medical societies can come together in the interest of their common constituency—the patients that insurers and physicians alike are pledged to serve. This historic settlement gives everyone reason for optimism and it is Judge Moreno’s wisdom that has made possible the better healthcare system that will result for all.”
Judge Dismisses Chiropractors’ Case Against Trigon
VIRGINIA: In what defense lawyers are calling a significant victory for the managed-care industry, a federal court in Virginia has granted a health insurer summary judgment in a lawsuit alleging antitrust conspiracy.
The U.S. District Court for the Western District of Virginia granted summary judgment to Trigon Healthcare Inc.—which merged with Anthem Inc. (NYSE:ATH) in July 2002—in a lawsuit brought by the American Chiropractic Association, the Virginia Chiropractic Association and individual chiropractors.
Plaintiffs had said the case was the most significant legal action ever taken by the chiropractic profession against the insurance industry and called it a test of future action, according to a statement from Trigon’s attorneys at McGuireWoods law firm. The court also said Trigon wasn’t liable for attempted monopolization because it didn’t compete in the market for treatment of neuromusculoskeletal disorders, the attorneys said.
The ACA, VCA and ICA called the opinion from U.S. District Judge James P. Jones “legally and factually wrong” and “full of holes.” They will “vigorously appeal” the unfavorable ruling.
Chiro Wire TAC
Written by TAC Staff: Yellow Pages
Thursday, 30 January 2003 00:00
Arkansas Chiropractic Board Fines PT
ARKANSAS: Until recently, Arkansas had never had a case in which a physical therapist appeared before the state chiropractic board in a disciplinary hearing.
But last month Michael Teston, a physical therapist who allegedly performed “spinal manipulation” on a patient and a private investigator, incurred $10,000 in fines ordered by the Arkansas State Board of Chiropractic Examiners, the Arkansas Democrat-Gazette reports. One of Teston’s patients claims Teston “popped” her back, and that sound usually indicates spinal manipulation, the board executive director explained. Under state law, physical therapists can only manipulate joints and not the spine, so they can perform “spinal mobilization” but not “spinal manipulation.”
The state Board of Physical Therapy, however, backs Teston. The PT board’s chairman states that Teston’s case will have “some huge ramifications,” such as pressuring therapists to treat patients more conservatively, the Democrat-Gazette reports.
Teston plans to appeal the chiropractic board’s order in circuit court.
Watch your timing!
NEW JERSEY: A New Jersey man practicing chiropractic without a license was sentenced to probation and a hefty fine under the Civil Insurance Fraud Prevention Act in early January. Thomas S. Boselli was sentenced to two years probation, and also was ordered to pay a $100,000 fine.
Boselli had had chiropractic training, but he wasn’t properly licensed at the time he submitted claims for services to several insurance companies. He pleaded guilty on Oct. 28, 2002, to a criminal accusation filed by the Division of Criminal Justice-Office of Insurance Fraud Prosecutor, which charged one count of falsifying records.
The accusation alleged that on Jan. 24, 2001, Boselli sent a claim form to Horizon Blue Cross/Blue Shield as if he held a valid chiropractic license, when he didn’t have one.
The Latest on LIFE
GEORGIA: Remember back in December of 2000 when four professors at Life University filed a discrimination lawsuit against the school, saying they were humiliated when Sid kept referring to them as “New York Jews”? Well, in mid-December 2002, a federal judge ruled that a jury can consider the claims of the former faculty members who contend they were subjected to a hostile work environment and fired based on their Jewish faith.
6 of 11 complaints made in that lawsuit are being allowed to go to trial. Other complaints made by two of the professors, including slander and disability-related discrimination, were dismissed. The former employees are seeking damages including back pay.
That’s another kick in the teeth for Life; and Life is mad as heck, and not going to take it anymore! Finally fighting back, Life filed a lawsuit in early January, asking that a federal judge immediately reinstate its chiropractic accreditation, and seeking damages from the Council on Chiropractic Education for stripping them of their good standing.
In its decision last June to revoke the accreditation, the CCE cited management and academic deficiencies, including insufficient supervision of students in Life’s public chiropractic clinics. Life lost its appeal of the decision last October.
Life’s lawsuit contends the CCE has become dominated by proponents of a philosophy of chiropractic that advocates a closer relationship with the medical field, whereas Life was founded to promote an approach that maintains a division in treatment and diagnosis between chiropractors and physicians.
The lawsuit says CCE violated its own policies by sending representatives of competing chiropractic schools to review Life’s accreditation. Review team members from schools in Texas, California and Missouri “aggressively solicited” transfer students from Life, the lawsuit states. A representative of Logan College of Chiropractic near St. Louis was on an appeal panel that revoked Life’s accreditation. Within days, the chairman of Logan’s board of trustees made an offer to purchase Life, the lawsuit states.
And Life goes on...
The Atlanta Journal-Constitution TAC
Page 22 of 23