Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 83 I
"Righting a Wronged Ship"
The Most Important Consult I Have Ever Written
I was working at 6 AM and sat quietly thinking, "What is the most important contribution I have made to chiropractic?" As many thoughts came to my head, one stood out, integrity. Our profession, like every other profession, has issues and people, each with their own stories. When I think of being the best of the best, that includes losing...with integrity and that transcends professions. It goes to success in life.
I would rather lose with integrity than win by cheating a patient or the system and that includes the carriers. Over the years, too many doctors have confided in me as their consultant that they have cheated the system. Some have done so knowingly, while others have done so, initially, without their knowledge. The issue isn't whether they knew or not, it's what they did with the information they then had.
Example 1: A doctor in New York told me that the carriers had lied and cheated so much that he felt he was in a good place by adding services to his bill to balance THEIR fraud of denials.
Example 2: A doctor in Michigan told me that he upcoded e-stim to the fully attended vs. non-attended code and did so for 3 years.
Example 3: A doctor in Georgia told me that she sub-let from a massage therapist who did her billing. The massage therapist's billing staff used codes they were familiar with which did not accurately represent the services rendered, but enabled the doctor to get paid.
Example 4: A doctor in Massachusetts told me that his staff wrote all of his SOAP notes to match the billing codes he provided and each time those codes were for a 5 level adjustment regardless of the services rendered.
Example 5: A doctor in Missouri told me that he adds a modality to many visits to maximize the number of allowable billing units for a certain carrier as suggested by a respected consultant (not me).
Example 6: A doctor in New York told me that his billing company added services he was not aware of and then kept the excess income and payed him for his actual services. They did so without his knowledge for years. Although the doctor got a copy of the explanation of benefits (EOB), the billing company knew the doctor was too lazy to carefully review the EOBs which was the reason they chose to exploit this doctor.
In each of the above scenarios, the doctor committed insurance FRAUD which is a felony in every state in the country. Should any of these doctors not have taken the action I will be prescribing below, he/she would probably have ended up losing his/her license, been financially ruined and possibly sent to jail.
Hopefully, all of you do not have any of the above scenarios to deal with...but...if you do or you are not sure, the first thing you need to do is call me and give me a complete set of accurate facts. I will first "talk you off the ledge" as you do not need to jump. I will not sit in judgment of you and I will let you know how proud I am that you have decided to "right your ship." I will then give you action steps to take to undo anything you have done, short of murder. The recommendations are always painful, but far less painful than if the carriers, licensure board, district attorney or FBI white collar crime unit comes knocking first. Do not put anything in an e-mail because the "e" in e-mail stand for evidence against you as everything you send to anyone except your lawyer is admissible in court and will be held against you.
The best time to resolve a problem is right now. It is far less costly and stressful when you are in control of the circumstances. The carriers profile EVERY office nationally and are extremely sophisticated with metrics that will predict your every bill and treatment patterns and compare them against national norms. Beyond that, it goes to integrity. Your integrity is one of the immutable factors of success in life. Without it, you are destined to be an abject failure in life.