Academy of Chiropractic

Quickie Podcast 1296
Infrastructure 261 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

How to Avoid a Federal Law Suit

 

 

Speaker 1:

All right. This has been recorded with permission. Good afternoon. Good afternoon. Okay. So you wanted to know what was going on with the Rico cases, correct? That is correct. Specifically in New Jersey. Okay. Well, it's not New Jersey. It's national. Okay. Um, and the New Jersey office is controlled by a law firm. That's predominantly out of New York and I have relationships with the, uh, a lot of the, the attorneys out of the firm. So I think that the cool part is, is I get to see what's going on from the other side before it happens. So what's happening is, is the carriers made the decision, uh, Baco, um, and state farm specifically in Liberty to follow up back in, um, uh, in March, just before COVID hit that they were going to quadruple, but not quadruple four fold increase. That's quadruple. Yes. They were going to quadruple their Rico division because it's a good money maker for them.

Speaker 1:

And they're very successful at it. And they are finding new algorithms. Now, have you been reading in the chiropractor magazine, the, um, articles that I've been sending out on predetermined treatment plans? Have you seen them? Yes, I have. They're all the issues that the carriers are going after and they're very successful, but what they used to do is they used to look for runners. There's not that many out there anymore. Then what they do is they look for billing for services that didn't happen. There's not that many out there anymore. Then they look for, um, um, doctors that have kicked back relationships. There's not that many of those anymore. So now what they're doing is they're looking for, uh, they're aggregating statistics over a decade. For instance, if you're going to use, say over 40 diagnoses per injury, I mean, what doctor uses over 40 diagnosis, other than the demented chiropractor who took some course on Colossus?

Speaker 1:

The answer is nobody. Okay. So if you have 92% of your patients with 40 diagnoses or more, the only reason you're doing that predominantly is to bust the Colossus algorithm does not make them happy if you are working with the same surgeon and that person gets referred a hundred percent of 96% of the time, that also raises a big consideration and a flag. If you're doing the same treatment to a patient, the same, um, cervical thoracic lumbar adjustments to every single patient that raises a flag. And do you have a symptom of clinical finding and a diagnosis for every one of those patients that you're, that you're treating in those areas? How good is your paperwork? So what the carriers are doing is aggregating statistics over a decade, and then that is the basis for their Rico suits. And it's, it's really, you know, it's the power of the computer, it's the information age.

Speaker 1:

So you've gotta be really good at what you do and, you know, and, and I don't want to say mix it up. You only treat what's there, but be really careful. You don't fall into, um, uh, I don't want to a lazy pattern of how you do things is very specific for patient because that's what the carriers are doing. And it's very real. And, um, um, interestingly enough, one of our doctors in, uh, in Florida joined the program in 2018 and he was interviewed by state forum in 2018, stay for a big drop, a Rico case on him and said, it's everything before you started with dr. Student. So, you know, so that's kind of validation for what we're doing is working and you just got to follow the bouncing ball. Does that answer your question and understood, thank you very much. Anything else? Cause I, I know too much about this much more than I want to find LinkedIn in Jersey. CarePath how does that affect these Rico suits? Well, you follow care path, uh, putting your variances, um, make sure you document that appropriately, but it's the same all the way down the line. It's not about career path, just as big, as long as your documentation is good. You don't have a problem. And I know you and you've got good documentation. Thank you very much. Got it. Got it. Later alligator. Have a great day. You too. Bye. Bye.

 

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