Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 614
Infrastructure 145 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues I bring are small, yet each issue is just that… an issue. If you take care of the small issues, then you will be able to build and focus on the larger issues… a larger, more profitable practice along with more family time. 

“Carrier Fraud Alert”

Carrier Fraud Alert… 3-9-2016

 
As I wrote yesterday in the quickie consult about carriers' claims reps denying medical care by medical decision making, it has come to my attention through feedback nationally that this problem is far more prevalent than I first reported. At first, I had evidence in Alabama, Mississippi and Texas. Now I have evidence that this is a national trend in so many more states and the carriers are training their staffs to commit fraud and felonies according to the lawyers. 

Therefore, you MUST review your EOB’s and see if your care is denied for necessity issues where there is no IME or peer review by a licensed provider. In the absence of a licensed provider’s opinion, and in most states that must come from a licensed chiropractor, then the claim rep is practicing chiropractic or medicine without a license. Complaints must be made to the department of insurance and “whistle blowing” to the legal authorities inclusive of the Attorney General’s Office in your state is appropriate.

You need not fear retribution unless you are not documenting accurately or committing fraud yourself, which is rarely the case with my clients. As a side note, I have kicked out many in our program who I have found out were not honest or were unwilling to fix the documentation errors when doing audits. I am a firm believer of wearing the white hat; any color of gray cannot exist as the stakes are too high.
 
 


Respectfully,



Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

 
Academy of Chiropractic
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