Chiropractic Association Files Suit against Aetna ILLINOIS: The Illinois Chiropractic Society (ICS). the largest chiropractic association in Illinois, recently announced that it has joined with three other chiropractic associations and several individual plaintiffs in filing a lawsuit against Aetna, seeking nationwide relief on behalf of chiropractors and other healthcare professionals. The law firm of Buttaci & Leardi, LLC, in concert with the class action law firm of Pomerantz Haudek Grossman & Gross LLP, represents the ICS in the lawsuit, which challenges Aetna's improper recoupment demands on chiropractic physicians and other healthcare providers. The action alleges that Aetna's post-payment audit process violates the Employee Retirement Income Security Act of 1974 (ERISA). and further alleges that Aetna's post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act (RICO). The action also attacks Aetna's clinical policy bulletins that are used to deny services retroactively. The suit has been filed as a class action on behalf of all healthcare providers nationwide who have been harmed by Aetna's conduct. The ICS has joined the action in a representational capacity on behalf of its members. "Retroactive reviews, post payment audits and recoupment demands are becoming far too common in the insurance and healthcare arena. Many of our members and other healthcare providers around the country are harmed by these practices." said Marc Abla, CAE, Executive Director of the ICS. "It is unjust for both the provider and patient when the insurance company demands return of payment for past claims, sometimes years after the service was performed and payment rendered." In addition to challenging Aetna's recoupment effort, the lawsuit challenges Aetna's justifications of its repayment demands. The ICS finds that a substantial portion of Aetna's justifications relate to chiropractic services that Aetna deemed after the fact to be experimental and investigational and, therefore, not covered services under the applicable health care plans. The Complaint seeks: (1) to stop Aetna from continuing to engage in impermissible audit and recovery practices; (2) to stop Aetna from enforcing clinical policies that are substantively baseless; (3) compensation for chiropractors who have been coerced into making payments to resolve or defend against Aetna's unlawful overpayment actions; and (4) to order Aetna to find that certain chiropractic services are covered under the plans Aetna offers, underwrites or administers. Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. For more information, contact Marc Abla, CAE, Executive Director for the Illinois Chiropractic Society by emailing marc@ ilchiro.org or by calling 1 -217-525-1200. Valley Doctors, Chiropractors Accused of Fraud CALIFORNIA: Allstate Insurance Co. is suing San Joaquin Valley doctors and several chiropractors in a multimillion-dollar lawsuit, alleging they falsely operated chiropractic clinics as medical groups to get insurance payments. The lawsuit in Fresno County Superior Court also says that the doctors and chiropractors created sham professional medical corporations to illegally purchase and distribute prescription medication to chiropractic clinics and patients. The lawsuit seeks damages in excess of $3 million as well as statutory penalties. And the insurance company seeks more than $1 million in damages, penalties, attorneys' fees and costs for violations of California's Insurance Fraud Prevention Act. The lawsuit names more than a dozen defendants, including chiropractors Dolphus Dwciyne Pierce II of Lemoore. John Brent Arakelian of Fresno and Drs. Tomas Ballesteros Rios of Bakersfie/d and Charles Orlando Lewis III ofHanford. According to the lawsuit, Pierce established fake medical corporations for the purchase, storage, reselling and dispensing of prescription drugs. And he enlisted doctors to prescribe, deliver and dispense the drugs, the suit says. Chiropractors licensed by the state of California are not allowed to prescribe or dispense prescription drugs. The suit says Pierce knew the plan was illegal, but that having licensed doctors prescribe medication would increase the value of claims that could be filed with Allstate. In 2003 and early 2004, the suit says Pierce and his wife, Cathy Aguilar Pierce, hired Rios to falsely appear as the majority owner of Pierce & Rios Med. Corp., Rios & Pierce Med. Corp. and P&R Med-Legal. All were "sham" medical corporations, according to the lawsuit. Wilkins said the corporations listed in the lawsuit have not been in operation for several years. The suit says Rios knew it was illegal when he agreed to pose as a "sham" owner of a medical corporation to circumvent the law. Rios could not be reached for comment. Wilkins said he was not now representing Rios. In 2004, the suit says, Rios entered into agreements with a number of chiropractors to appear as majority owners of multiple medical corporations in exchange for money, to give the false appearance that the corporations were in legal compliance. According to the suit, Arakelian was one of those chiropractors; on June 29, 2005, he entered into an agreement with Rios in which Rios would pose as the majority owner of San Joaquin Accident & Medical Group Inc. The office is at Gettysburg and Cedar avenues in east-central Fresno. When Rios pleaded guilty to a felony of making or subscribing to a false income tax return on May 25. 2007. Arakelian removed Rios as the owner of the medical group in mid-2007, the suit says. Rios was replaced by Lewis and Dr. Chan Woo Lee of South Gate in Los Angeles County, the suit says. Pierce became a part-owner. Source: The Fresno Bee 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 [email protected] or #CO138, 8619 NW 68th St., Miami, FL 33166.
