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OSCA Leads the Nation With ERISA UHC Class Action and PPACA Compliance for Patient Protection
Yellow Pages
Written by TAC Staff   
Monday, 25 April 2011 21:24

aroundtheworld

COLUMBUS, OH--(Marketwire - 03/18/11) - On March 16, 2011, Ohio State Chiropractic Association (OSCA) announced that it was sponsoring the second PPACA Claims Regulations Claims Specialist training in an effort to meet a July 01, 2011 deadline for full enforcement of the Federal Health Reform Law, Patient Protection and Affordability Care Act (PPACA). PPACA is the new Federal Patient's Bill of Right, for almost all non-Medicare and non-Medicaid health claims and OSCA believes that it is critically important for health care providers as well as their patients to understand what is involved in this important new legislation. Earlier this year, on Jan. 24, 2011, OSCA and Dr. Judson G. Sprandel, II, D.C., past president of OSCA, filed a class action lawsuit against UnitedHealth group for the alleged violation of the Employee Retirement Income Security Act of 1974 ("ERISA"), arising from its post-payment audit and stethoscopeandflagrecoupment practices. The OSCA's Board of Directors unanimously (19 - 0) voted to file this suit in early January. That decision was driven from a commit to protect the rights of its members and the insured they treat through use of ERISA, the federal statute governing most private employer benefit plans. On Feb. 8, 2011, the Congress of Chiropractic State Associations ("COCSA") announced that it had voted to join OSCA in pursuing the ERISA Class Action on behalf of providers nationwide. COCSA represents chiropractic member associations in in all 50 states. The American Medical Association described the pending class action in its member publication on March 4, 2011, stating that "the lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors." Through the ERISA class action against United and the PPACA Claims Appeal Compliance training OSCA is leading the nation in advocating for appropriate patient care and against abusive insurance practice.

The Second OSCA PPACA / ERISA Claims Specialists training will be held on April 28, 2011 in Columbus, OH for its PPACA / ERISA Committee Members. Once the eight module trainings are completed the OSCA will begin training all members and providers in the State. OSCA finished its first session in PPACA / ERISA training on March 3, 2011.

The OSCA's ERISA class action was originally filed on Jan. 24, 2011, in the United States District Court, District of New Jersey, Case 2:11-cv-00425-FSH-PS, by Pomerantz Haudek Grossman & Gross LLP. Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of ERISA.

PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare and Medicaid, the most significant reimbursement law changes in 45 years since Medicare was created. The PPACA claims regulations became effective on 09/23/2010 with a deadline on July 01, 2011 as full enforcement grace period.

On July 23, 2010 the United States Department of Labor released a bulletin entitled: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule. You will find a copy of this bulletin here

These interim final regulations are effective on September 21, 2010.

Information regarding the OSCA and membership benefits can be accessed at http://www.oscachiro.org

 

Pass on the information to inform other D.C.’s about events that are really happening to chiropractors.

For further information, fax 1-305-716-9212. Write us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or #CO138, 8619 NW 68th St., Miami, FL 33166.

 
Arizona Chiropractors Versus Department of Insurance
Yellow Pages
Written by TAC Staff   
Monday, 25 April 2011 21:20

aroundtheworld

azchirologo

PHOENIX, AZ: Two Chiropractors and a patient, backed by the Arizona Chiropractic Society (ACS), filed a lawsuit on the 14th  against the Arizona Department of Insurance (ADOI) alleging failure to enforce the chiropractic insurance equality law, ARS 20-461(A)17 and ARS 20-461(B). This law requires insurers to give patients the option to use their health insurance to see either an MD, DO or DC for neck and back problems and pay the same copays and deductibles with the same overall limitations on treatment. Currently, copays, deductibles and other limitations for chiropractic care discriminate severely against chiropractic care with financial barriers so huge that insurers, led by Blue Cross Blue Shield of Arizona, basically force patients to choose MDs or DOs for back and neck pain. ADOI, despite hundreds of consumer complaints, has refused to enforce this law which only they have the legal authority to enforce. Therefore, this legal action asks the courts to order ADOI to properly enforce the law. To read the official filed and stamped lawsuit documents go the Arizona Chiropractic Society’s website, www.azchiropractors.org.

Source: Arizona Chiropractic Society

 

Pass on the information to inform other D.C.’s about events that are really happening to chiropractors.

For further information, fax 1-305-716-9212. Write us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or #CO138, 8619 NW 68th St., Miami, FL 33166.


 
Chiropractic News around the World
Yellow Pages
Written by TAC Staff   
Tuesday, 12 April 2011 11:41

Chiropractor Attacked for Advertising Claims
Associated with DRX-9000 in California
CALIFORNIA:     A Danville chiropractor has been pushing a device via his website to thousands of chiropractors with false claims that it's approved by the FDA and endorsed by NASA, the Alameda County District Attorney's office said in a news release.
Dr. Benjamin Altadonna made or caused to be made a traction device which he "sold or leased for between $90,000 and $115,000," according to the complaint. He advertised the device with deceptive claims as the "DRX9000 New Cash Patient Marketing System" or the "DRX9000 Spinal Decompression Lead Generation and Conversion Marketing System," the State said.
"Many different counties joined in on the lawsuit and decided to file it [in Alameda County," said D.A. Teresa Drenick. Contra Costa, Marin, Monterey, Napa, Orange, Santa Clara, Santa Cruz, Shasta, Solano, and Sonoma counties are all part of the civil complaint.
In 2006, the D.A. said, Altadonna made claims that "the DRX was a patented device having FDA approval or that it was used in a valid scientific study that demonstrated an 86 percent success rate in treating medical conditions like spinal herniation… that the DRX was affiliated with, endorsed or approved by NASA." The state of Oregon also fined Altadonna for similar things in 2007, the D.A. said, noting Altadonna does business as Doctor's Wealth Creators and other names.
According to Altadonna, he entered into a stipulated agreement with Oregon's attorney general in 2007, requiring the chiropractor to change his marketing practices and provide "reliable scientific evidence such as tests, analysis, research, studies…based on the expertise of professionals in the relevant area" to back up his claims, which Altadonna neglected to do.
Altadonna, under the umbrella Altadonna Communications Inc. (ACI) paid civil restitution as part of the agreement.
But, according to the Alameda County D.A., Altadonna is again using pseudonyms to sell and disseminate "thousands of marketing plans to thousands of licensed health care professionals inside and outside the State of California."
After meeting with the Monterey County D.A. in 2006, Altadonna began transferring assets to co-defendants Altadonna Living Trust and Diablo Park LLC, the state said.
California is seeking an injunction and penalties for false advertising, unfair competition, fraudulent transfer of assets and violations of the Business and Professions Code.
While the next court date and judge have not been assigned, Scott Patton, one of the prosecuting D.A.s, says there is no chance that Altadonna will go to jail.
"Since this is a civil complaint...the court will usually order injunctive terms and (Altadonna) will have to conduct business a certain way and may have to pay restitution if there are injured parties."
Danville Express


Probation for Chiropractor in Insurance Fraud
PENNSYLVANIA:  A Bucks County chiropractor who participated in a scheme to bilk Independence Blue Cross of almost $2 million was sentenced recently to three years' probation and ordered to perform 450 hours of community service.
U.S. District Judge Gene E.K. Pratter gave Dr. Raymond W. Brozek, 57, of Telford, a big break after Assistant U.S. Attorney Anita Eve filed a motion for leniency based on "substantial" assistance from Brozek that led to charges against others.
Two other defendants in the case—Michael Karp and Mark Levin—were sentenced to prison terms of six months and a year and a day, respectively, in September and November.
Brozek, who is no longer practicing and likely faces suspension of his license, is working as a chauffeur. He admitted lately that he had made a "terrible, terrible mistake."
Authorities said Levin, 65, and Karp, 39, who is Levin's son-in-law, owned Hatfield Athletic Club and Rehab One, a chiropractic office at the club.
The men hired Brozek to work there from 2004 to 2006. Levin demanded that Hatfield workers be seen by Brozek as often as possible so he could bill IBC, prosecutors said.
Prosecutors said Brozek followed his superiors' directions and caused fraudulent bills to be submitted for treatments either he didn't perform or that weren't medically necessary.
Authorities said Brozek also prepared bogus bills that were used to submit claims to IBC that represented services provided to Hatfield workers, who were encouraged and forced to sign Rehab One's patient log regardless of whether they were treated.
At the direction of Karp and Levin, Brozek created office notes and other documents that included fictitious procedure codes and false depictions of symptoms and clinical findings, which were used to prepare bills submitted to IBC.
Authorities said the defendants submitted almost $2 billion worth of medical bills to IBC, resulting in payments from IBC of $399,882.
The three defendants must make a combined restitution of $399,822 to IBC.
Philadelphia Daily News

 
Chiropractic News Around the World
Yellow Pages
Written by TAC Staff   
Thursday, 18 November 2010 11:06

Double Hand Transplant for Burnt Chiropractor Successful

LOUISVILLE, KY.:  The recipient of a rare double hand transplant says he feels "fantastic" and can wiggle fingers on both his new hands.

Richard Edwards made his first appearance on Thursday, about a week after he underwent a nearly 18-hour transplant procedure at a hospital in Louisville.The 55-year-old chiropractor from Edmond, Okla., had his hands severely burned in a fire in 2006.
Edwards was the nation's third double hand transplant recipient. The surgery was performed at Jewish Hospital, the site of the world's first successful hand transplant in 1999.
Doctors say Edwards' progress is ahead of other patients because they were able to route his existing nerves into the donor hands. Edwards lost seven fingers after his accident but retained most of his original hands, though they were badly burned.
Source: Huffington Post


Illegal Search Warrant Exonerates Chiropractor on Drug Charges

BOWLING GREEN, OH--The Sixth District Court of Appeals has overturned a conviction of a local chiropractor. The Doc was originally charged with allowing drug abuse in her home.
Huntington entered the plea after a motion to suppress evidence, filed in August 2009, was denied by a Bowling Green Municipal Court. At issue was a search warrant filed and executed while the chiropractor was away from her home. The warrant was obtained when a friend who was feeding her cat gave police permission to enter the chiropractors home.
While at the home of the chiropractor “feeding the cat”, the friend found items which led him to contact the police, who then obtained a warrant. The appeals court ruled that the friend "merely had (the chiropractors) permission to enter the kitchen to feed the cats on three separate days; the cat feeders presence in appellant's house could reasonably be expected to amount to no more than five or 10 minutes on each occasion."
The Judge that granted the warrant presided at the chiropractor’s plea agreement.
The appeals court added that her friend was not staying in the house overnight and he was not given authority over the premises.
"We find that appellant's home was searched illegally and that the trial court therefore erred by denying appellant's motion to suppress," the panel of three judges concurred.
They ruled in favor of the chiropractor's appeal and sent the matter back to the municipal court.
Source: The Sentinel-Tribune


Chiropractor wins $6.3 Million in Judgement Against the State Board

INDEPENDENCE, MO--A chiropractor in Missouri has won a $6.3 million judgment in his case against former members of the Missouri State Board of Chiropractic Examiners for suspending his license.
The case stems from accusations that a chiropractor, who ended up leaving Missouri after the accusations, had convinced a Mennonite farmer with AIDS that he was cured and could start a family.
The patient died and left behind a wife and daughter, each with HIV infections. From the beginning, the chiropractor has denied that he ever said the patient had overcome HIV.
After the case came to light in stories published in The Kansas City Star, the chiropractic board suspended the chiropractor’s license for two years — although that suspension was set aside pending appeals that the chiropractor ultimately won in 2002. The board could have tried again to impose its penalties, but it never did, and the chiropractor’s departure from the state would have made disciplinary action moot.
But he filed suit against the former board members in 2005 to collect legal fees and losses to his business. That case went to trial last week. In a 9-3 verdict, the Cole County jury awarded damages of $6,284,759.
Attorney General Chris Koster’s office represented the board members, and a spokesman said the state planned to file a post-trial motion to have the verdict set aside. The chiropractor's attorneys could not be reached for comment.
The case stretches back 20 years, when the patient whent to the chiropractor's office several times beginning in 1990.
The patient was a member of a Mennonite sect from north-central Missouri, had hemophilia and contracted the AIDS virus from tainted blood products. He died in 1992.
At dispute in the case is whether the chiropractor told the patient that the treatments cured him of AIDS.
The chiropractor won his appeal in 2002 in large part because a court said he had not been given access to key pieces of evidence. One was testimony the deceased patients widow, which was given in an unrelated lawsuit involving tainted blood that caused the patients AIDS. The chiropractor argued that testimony in that case would vary from the widow’s testimony that chiropractor said the patient was cured.
The chiropractors' suit also contended that the chiropractic board seemed to overlook a religious anointing ceremony at the patient's church which was held in hopes of curing him, and the urging made by the minister at his wedding that the patient start a family. The chiropractor suggested those factors might have led the couple to believe patient was cured or to conceive a child even if he remained HIV-positive.
The jury’s verdict came against six former members of the chiropractor board — Lawrence Gerstein, Charlotte Hill, Mary Holyoke, Charles Klinginsmith, Larry Lovejoy and Lee Richardson. Ordinarily, members of such boards are immune from civil suits for their official duties. But there is an exception when a court finds they acted with gross negligence. Still, the state’s legal expense fund will ultimately cover any damages.
Source: The Kansas City Star

 
Chiropractic News Around the World
Yellow Pages
Written by TAC Staff   
Friday, 08 October 2010 16:43

N.J. High Court to Hear

Chiropractors’ Appeal

NEW JERSEY: The State Supreme Court has agreed to hear an appeal of a lower-court decision out of Ocean County, NJ, that has barred chiropractors statewide from performing procedures they had been doing for decades and are allowed to perform in the 49 other states.

Among cases posted in mid-October on the state Judiciary’s Web site that the state’s highest court has agreed to hear was one brought by patient Carol Bedford against chiropractors Anthony L. Riello and Peter E. Lowenstein and Coastal Chiropractic.

A decision in April by a panel of judges with the Appellate Division of state Superior Court ruled in the case that the state law governing chiropractic care limits chiropractors to performing adjustments of the spinal column. The ruling outlawed adjustments to extremities and other joints, which chiropractors had been doing for decades and are allowed to do in the 49 other states.

The decision is not only impacting the businesses of many of the state’s 2,500 chiropractors, but also is affecting their patients, who have come to rely on extremity adjustments but can no longer have the procedures done in the state, according to the Association of New Jersey Chiropractors (ANJC) .

Following the appellate court decision, the defendant chiropractors appealed, and the association filed a brief in support of the appeal. The Supreme Court, in late September, granted certification to hear the appeal.

Since the appellate decision, the association had collected signatures of more than 30,000 patients supporting the practice of extremity adjustments.

The ANJC has been addressing the lower-court ruling on two fronts: supporting the appeal and also lobbying to change the law to allow for extremity adjustments. A statute that would do that was passed in the Assembly on June 21, the Legislature’s last day in session before the summer break. But the Senate sent it to its Commerce Committee, where it still sits.

Asbury Park Press

Chiropractor Gets Jail Time for

Not Filing Tax Returns

FLORIDA: A Vero Beach chiropractor was sentenced to eleven months in prison in late October after being convicted of failing to file income tax returns, according to the U.S. Attorney’s Office. Stephen J. Short Jr. was convicted after a three-day trial in July of four counts of willfully failing to file returns. Prosecutors said he didn’t file returns in 2000, 2002, 2003 and 2004 and earned an annual income between $87,000 and $124,000 during that time.

Short faced up to a year in prison on each count. After he completes the prison time, Short will spend one year on supervised release and U.S. District Judge Donald Graham ordered him to pay the Internal Revenue Service $47,000 in restitution.

TCPalm

From the "Different Strokes" Department….

GEORGIA: A Columbus chiropractor who pleaded guilty to not filing his income taxes received probation recently in federal court. Robert D. Ressmeyer, 68, was sentenced by U.S. District Court Judge Clay Land to three years probation on two counts of failure to file a federal income tax return. The chiropractor, who could have faced 12 to 18 months in prison, had pleaded guilty in June and remained free on bond.

"Your honor, I have no excuse that I can render for the situation I got myself into," Ressmeyer told the judge. "I apologize for the grief I got my family into. My fervent prayer is that I be allowed to continue my practice."

Ressmeyer was accused of not filing a federal tax return for the years 2000 and 2002 on $163,335 and $176,145 in annual incomes, respectively. The government contends that the operator of Ressmeyer Chiropractic Life Center hadn’t filed a return since 1997, and Ressmeyer agreed in his plea agreement that he didn’t pay $152,084 in taxes between 1998 and 2003.

Ressmeyer’s attorney, Richard Childs, said his client’s failure to file taxes started out small and could have been corrected in the beginning. However, the problem grew until it reached the point of a guilty plea and sentencing in federal court.

"He’s a good man who did a bad thing," Childs said.

Childs estimated that Ressmeyer owes between $250,000-$300,000 in back taxes and interest.

Explaining that federal sentencing guidelines called for 12 to 18 months in prison, Land said that would be inconsistent with the goals of sentencing.

Prison time, Land said, wouldn’t protect the public or impose a healthy respect for the law.

Assistant U.S. Attorney George Christian said he would speak with tax authorities before deciding whether to appeal the sentence.

Ledger-enquirer.com

 
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