Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1152
Infrastructure 237 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very 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 more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"Geico's lawyers and compliance Part 1"

 

Dr Studin: I'm sitting and chatting with Dr Bill Allen. So I just finished having an hour and a half meeting with one of the leading law that both Geico and state farm uses to represent them in coming after doctors, he reached out to me and wanted to sit with me, I got him through a friend of the family and they're based out in New York City and After a few cancellations, we finally had a meeting and it was revealing. you've had in your office situations with eos with different carriers.

Guest Doctor: Yes, absolutely. That nasty gram that comes in the mail and they want all them your stuff.

Dr Studin: Well, actually that's a retrospective audit. But an examination under oath is when you go into a lawyer’s office with a court demographer, are they coming to your office or the courts demographer. And they start asking you formal cartoons on the record. And usually that's the circle the wagons to go after you. And they often stopped paying. Now you've ever had an experience where they stopped paying, you'll have you?

Guest Doctor: Oh yeah. I got the letter. So I had four letters in a row that came from one carrier and it was a total of 147 cases and they wanted an EUO, every single case individually. And they sat until they investigate that they haven't problems to stop payment, what I did though, as soon as I got the first letter, I had my healthcare attorney set up an appointment three days immediately go down there. So I wasn't scheduled within 10 days or they're seated at first letter, cause even on my consulting side, that's kind of in a way what they're hoping for as well is that the doctor did scared because they don't have their stuff together and they delay and they don't go in and that just takes the hand farther down.

Dr Studin: And what happened after you went in with your lawyer?

Guest Doctor: Well, actually what I did was I organized all the cases, the first like 36 and then the letters just keep coming and it was getting a little bit absurd to organize the file, but we got a scheduled within 10 days, five pm on Wednesday, 5:00 PM on Tuesday, the day before I was supposed to go in, we got a call from this law firm that said, we no longer require you to testify, they're closing the matter and they company was instructed to pay.

Dr Studin: and it was Geico?

Guest Doctor: Yeah. So I never went in, even though I was prepared. I did have conversation with an attorney that knows those attorneys, his discussion with me was that really, I'm preliminary investigation corporately and paperwork lied. Everything was pristine, so they dropped,

Dr Studin: What we're finding is with the EUOs, I'm seeing it in Massachusetts and Florida and New York. I know it's happened to them a lot in Texas, and other municipalities. In Florida, they stopped paying Geico specifically for six months, just because they wanted to. And they kept every single patient and they wanted all the documents and not saying why wouldn't tell the doctor why, in Massachusetts EUO wrote every single patient, that's a problem. And I think they stopped paying also. we have your situation in New York and in Washington, there was a problem that, a board ordered action that occurred at the request of one of the personal injury carriers that they said the doctor, he had a multidiscipline and didn't do it properly. And then one of the carriers picked it up, I think it was all state and reported him to the board and he had a licensure action against him when they shouldn't have, and an all the cases I did a compliance review, the guy in Massachusetts, it turns out he was documenting a diagnoses and then differential diagnoses, which was different. He called his differential diagnosis in his mind to rule out diagnoses. And he diagnosed fracture herniated discs under the topic of differential diagnosis on every single patient, and every one of those patients were being Sued and they weren't paid, in Florida, I can tell you the doctor's a volume practitioner, he's a pretty much of a stretch shooter, and that's fine. In the state of Washington, It was the worst I've ever seen in a compliance review. And I've done over a thousand. The doctor documented incredibly poorly. Just the patient fill out forms and the forms are incomplete and the doctors had a very brief evaluation, no plan, no goals, no prognosis, no treatment plan, a couple of examinations, no review of systems, no chief complaint, no mechanism of injury, no past social. He didn't document anything, whatever the patient chose to fill out, which was quite cryptic. And that's what the doctor's been doing. So what I learned this morning from the attorneys of Geico and state farm specifically is they look for patterns and they are an office. There's like 50 lawyers in one office. They are an office of a Rico attorneys and that's where they're looking right now to create Rico violations because they can get damages if forces you into federal court, which means your lawyers fee doubles because the federal lawyer acceptance in the federal court is double and you no longer get a healthcare lawyer. You get a criminal defense lawyer at this level, what I said, well, what's to stop Geico or state farm or Allstate or anyone from just choosing to go after anyone for any reason? He said nothing. He said, that's the price of doing business in today's marketplace. I said, yeah, it's great for you to say your client, which is Geico has $10 billion. My client's making $150 hundred $160,000 a year. He's just keeping their head above water and now it's guilty until proven innocent. You stopped paying them because she can, and now what do we do? He says, well, you got to get a lawyer and hopefully make it go away. Well, how do you find the right lawyer? you have to find somebody who's connected with an insurance company through a relationship. How do you find that lawyers then? Well that's your job, not mine. You're supposed to be the consultant. You show them and tell them, but you've got to find the healthcare lawyer who does insurance health care. And that's usually where you start. And we have relationships with a lot of these people. We work with them a lot and they'll make a phone call, they'll have a sit down and they often can make it go away if you get the right connected lawyer. So I said, you're telling me that you'll go after this doctor for any reason. You'll stop paying them. They'll have to go hire lawyers for $800, $900 an hour in federal court. They're exposed to Rico charges, which gets damages. And they don't even know why. And this could go on for months or years without knowing why he said pretty much until it works its way through the court systems, which is not quick. I said, is that fair? He said that's the price of doing business and that's the system that the carriers are using in order to drive their business, which means profit.

Guest Doctor: what's interesting too is if you walk in, I have spoken, prostate,different medical doctors. This isn't just a chiropractic issue, right?

Dr Studin: No, this is all across healthcare

Guest Doctor: So for everybody that's listening to them, and we're just going to talk minimum here, The longer it languishes the greater the cost and the greater the savings for the carrier because they're still under that no obligation. Minimum you're looking at $150 to probably $175,000 in just in the age and start defending a Rico violation.

Dr Studin: And you can’t go for your malpractice because they don't cover fraud.

Guest Doctor: No, this is mortgaging your house. Get an attorney, $50,000 painter and hanger, and that's why the connection is critically important because understanding that in the end, Do Carriers and defense attorneys want to hassle doctors? Yes, but there's also a cost of doing business so they don't want to necessarily engage in a long-term quite that's going to bleed poppers without any return. So the earlier you can make sure and we didn't even really mention that. I mean you discussed a progress notes and clinical documentation, but one of the big reasons things that they do go after all. So it's corporate structure. You don't want to have having good tracks and licensed professionals in your practice are they chiropractors, are they MDs? What's your relationship? How are you billing? What tax id, then from a compliance perspective, listen, if you don't have that organized that here, just the sitting dock for that kind of stuff.

Dr Studin: and that's 100% and that's a big issue because this particular attorney does not deal in bodily injury. In other words, like the settling cases that patients bring against him. He deals at the corporate fraud level. That's where they deal with corporate fraud and the sense of improper corporate structure, improper billing, staging accidents and things along those lines. it's very clear it's guilty until proven innocent, I know from my experience of lecturing inside the insurance industry, it's like they say this is how we're going to get them, whether we're guilty or innocent, this is how we're going to get them, the bottom line is where a lot of this is spurred is your documentation. That's where it starts. That's where they start to look at you. If your documentation is poor, that's where it starts.

Guest Doctor: it's the signal, right? Because if you're not conscientious enough to make sure that your documentation houses in order, what other things are hidden under the rocks that they can overturn.

 

Dr Studin: I'm sitting and chatting with Dr Bill Allen. So I just finished having an hour and a half meeting with one of the leading law that both Geico and state farm uses to represent them in coming after doctors, he reached out to me and wanted to sit with me, I got him through a friend of the family and they're based out in New York City and After a few cancellations, we finally had a meeting and it was revealing. you've had in your office situations with eos with different carriers.

Guest Doctor: Yes, absolutely. That nasty gram that comes in the mail and they want all them your stuff.

Dr Studin: Well, actually that's a retrospective audit. But an examination under oath is when you go into a lawyer’s office with a court demographer, are they coming to your office or the courts demographer. And they start asking you formal cartoons on the record. And usually that's the circle the wagons to go after you. And they often stopped paying. Now you've ever had an experience where they stopped paying, you'll have you?

Guest Doctor: Oh yeah. I got the letter. So I had four letters in a row that came from one carrier and it was a total of 147 cases and they wanted an EUO, every single case individually. And they sat until they investigate that they haven't problems to stop payment, what I did though, as soon as I got the first letter, I had my healthcare attorney set up an appointment three days immediately go down there. So I wasn't scheduled within 10 days or they're seated at first letter, cause even on my consulting side, that's kind of in a way what they're hoping for as well is that the doctor did scared because they don't have their stuff together and they delay and they don't go in and that just takes the hand farther down.

Dr Studin: And what happened after you went in with your lawyer?

Guest Doctor: Well, actually what I did was I organized all the cases, the first like 36 and then the letters just keep coming and it was getting a little bit absurd to organize the file, but we got a scheduled within 10 days, five pm on Wednesday, 5:00 PM on Tuesday, the day before I was supposed to go in, we got a call from this law firm that said, we no longer require you to testify, they're closing the matter and they company was instructed to pay.

Dr Studin: and it was Geico?

Guest Doctor: Yeah. So I never went in, even though I was prepared. I did have conversation with an attorney that knows those attorneys, his discussion with me was that really, I'm preliminary investigation corporately and paperwork lied. Everything was pristine, so they dropped,

Dr Studin: What we're finding is with the EUOs, I'm seeing it in Massachusetts and Florida and New York. I know it's happened to them a lot in Texas, and other municipalities. In Florida, they stopped paying Geico specifically for six months, just because they wanted to. And they kept every single patient and they wanted all the documents and not saying why wouldn't tell the doctor why, in Massachusetts EUO wrote every single patient, that's a problem. And I think they stopped paying also. we have your situation in New York and in Washington, there was a problem that, a board ordered action that occurred at the request of one of the personal injury carriers that they said the doctor, he had a multidiscipline and didn't do it properly. And then one of the carriers picked it up, I think it was all state and reported him to the board and he had a licensure action against him when they shouldn't have, and an all the cases I did a compliance review, the guy in Massachusetts, it turns out he was documenting a diagnoses and then differential diagnoses, which was different. He called his differential diagnosis in his mind to rule out diagnoses. And he diagnosed fracture herniated discs under the topic of differential diagnosis on every single patient, and every one of those patients were being Sued and they weren't paid, in Florida, I can tell you the doctor's a volume practitioner, he's a pretty much of a stretch shooter, and that's fine. In the state of Washington, It was the worst I've ever seen in a compliance review. And I've done over a thousand. The doctor documented incredibly poorly. Just the patient fill out forms and the forms are incomplete and the doctors had a very brief evaluation, no plan, no goals, no prognosis, no treatment plan, a couple of examinations, no review of systems, no chief complaint, no mechanism of injury, no past social. He didn't document anything, whatever the patient chose to fill out, which was quite cryptic. And that's what the doctor's been doing. So what I learned this morning from the attorneys of Geico and state farm specifically is they look for patterns and they are an office. There's like 50 lawyers in one office. They are an office of a Rico attorneys and that's where they're looking right now to create Rico violations because they can get damages if forces you into federal court, which means your lawyers fee doubles because the federal lawyer acceptance in the federal court is double and you no longer get a healthcare lawyer. You get a criminal defense lawyer at this level, what I said, well, what's to stop Geico or state farm or Allstate or anyone from just choosing to go after anyone for any reason? He said nothing. He said, that's the price of doing business in today's marketplace. I said, yeah, it's great for you to say your client, which is Geico has $10 billion. My client's making $150 hundred $160,000 a year. He's just keeping their head above water and now it's guilty until proven innocent. You stopped paying them because she can, and now what do we do? He says, well, you got to get a lawyer and hopefully make it go away. Well, how do you find the right lawyer? you have to find somebody who's connected with an insurance company through a relationship. How do you find that lawyers then? Well that's your job, not mine. You're supposed to be the consultant. You show them and tell them, but you've got to find the healthcare lawyer who does insurance health care. And that's usually where you start. And we have relationships with a lot of these people. We work with them a lot and they'll make a phone call, they'll have a sit down and they often can make it go away if you get the right connected lawyer. So I said, you're telling me that you'll go after this doctor for any reason. You'll stop paying them. They'll have to go hire lawyers for $800, $900 an hour in federal court. They're exposed to Rico charges, which gets damages. And they don't even know why. And this could go on for months or years without knowing why he said pretty much until it works its way through the court systems, which is not quick. I said, is that fair? He said that's the price of doing business and that's the system that the carriers are using in order to drive their business, which means profit.

Guest Doctor: what's interesting too is if you walk in, I have spoken, prostate,different medical doctors. This isn't just a chiropractic issue, right?

Dr Studin: No, this is all across healthcare

Guest Doctor: So for everybody that's listening to them, and we're just going to talk minimum here, The longer it languishes the greater the cost and the greater the savings for the carrier because they're still under that no obligation. Minimum you're looking at $150 to probably $175,000 in just in the age and start defending a Rico violation.

Dr Studin: And you can’t go for your malpractice because they don't cover fraud.

Guest Doctor: No, this is mortgaging your house. Get an attorney, $50,000 painter and hanger, and that's why the connection is critically important because understanding that in the end, Do Carriers and defense attorneys want to hassle doctors? Yes, but there's also a cost of doing business so they don't want to necessarily engage in a long-term quite that's going to bleed poppers without any return. So the earlier you can make sure and we didn't even really mention that. I mean you discussed a progress notes and clinical documentation, but one of the big reasons things that they do go after all. So it's corporate structure. You don't want to have having good tracks and licensed professionals in your practice are they chiropractors, are they MDs? What's your relationship? How are you billing? What tax id, then from a compliance perspective, listen, if you don't have that organized that here, just the sitting dock for that kind of stuff.

Dr Studin: and that's 100% and that's a big issue because this particular attorney does not deal in bodily injury. In other words, like the settling cases that patients bring against him. He deals at the corporate fraud level. That's where they deal with corporate fraud and the sense of improper corporate structure, improper billing, staging accidents and things along those lines. it's very clear it's guilty until proven innocent, I know from my experience of lecturing inside the insurance industry, it's like they say this is how we're going to get them, whether we're guilty or innocent, this is how we're going to get them, the bottom line is where a lot of this is spurred is your documentation. That's where it starts. That's where they start to look at you. If your documentation is poor, that's where it starts.

Guest Doctor: it's the signal, right? Because if you're not conscientious enough to make sure that your documentation houses in order, what other things are hidden under the rocks that they can overturn.

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