Academy of Chiropractic

Quickie Consult 1269
Compliance 64 CA

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

Do You Know the Doctor You are Referring to?

It can drag you into a lawsuit!

 

“If its not bigger than me, I am not interested Mark Studin 2020

 

After reading more lawsuits, I am getting a clearer picture of what drags you into lawsuits. One large reason is collateral damage. The last lawsuit out of Michigan dragged two chiropractors due to the medical doctor they were referring to. That doctor "allegedly" falsified documents stating he was a Board Certified Orthopedic surgeon when he was not. He also lied about not having any previous licensure issues, when he had his license suspended for fraudulent activity in the past.

 

As a result, he was sued by Liberty Mutual as the prime defendant for his current work, performing MUA's (manipulation under anesthesia). However, they also brought in his referral sources into the lawsuit, stating the referrals were fraudulent. Also, they claim the treatment by the referring doctors were fraudulent. They painted a broad picture of everything attached to this MD, as committing fraud in everything they do. Regarding chiropractic care, Liberty Mutual contended, as a matter of strategy employed by every carrier's contemporary lawsuits, that all care was predetermined and unnecessary. They aggregated the statistics of years of treatment, and then "cherry-picked" examples to sway to the opinion of the courts. This proforma strategy allows the suit to continue and be immune to a motion to dismiss, which is the carrier's immediate goal. As a result, the doctors have to pay "significant" legal fees to get to the point in the case to "explain it away." By then, the carrier's strategy is either "drag this out" to financially burden the doctor with "Crushing legal fees or settle. Settlement typically comes with hefty fees and a stipulation for the doctor never to bill the carrier for the balance of their career.

 

This is a four-fold win for the carrier; 1) get paid back for services rendered, 2) collect three-fold under Federal Rico 3) then preclude these providers from ever billing again 4) get a corporate "boost," which bolsters their stock value.

 

For the doctors being sued, they have to back in time to defend every diagnosis, treatment order, referral, action, or lack thereof for continuing care, it gets more challenging. The lingering question that will have to be answered is, can their previous documentation arise to the occasion? The doctor's future depends upon their previous diligence or lack thereof!

 

THE SOLUTION

 

Don't put yourself in this position in the first place. We know enough about the carrier's tolerance for billing practices, and to minimize being swept into a lawsuit, stay away from the "land mines." Having an ongoing referral relationship with someone who has already been found guilty of fraud is a "RED FLAG." It is one that you need to weigh the merits of allegations, and should you choose to continue to work with this doctor, ensure that you do not have an exclusive relationship. Spread your referrals to many providers in the same specialty. I firmly believe in "second-chances" in life. However, it must be done with a modicum of conservatism, combined with common-sense.

 

In this particular case, it would be a deal-breaker if a doctor was previously found guilty of fraud, and then I verified his credentials to be falsely advertising that he was an orthopedic surgeon. At that juncture, I would be the whistle-blower. I always gather a doctor's CV before referring. I trust NO ONE with my patients and my future.

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