Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 29
Over the past few months, I have become more involved with being expert in defending doctors on issues pertaining to their license and insurance fraud. One of the most important functions I play is certifying that the doctor has upheld an appropriate standard of care, as reflected in their notes. This is also the primary area utilized by the plaintiff (insurance industry, usually) to defeat the doctor when suing for a variety of reasons. Please note, this is a business tactic by the insurer to get re-paid with interest and often for treble damages, as evidenced by the latest RICO charges.
The front page of the last issue of “The Dynamic Chiropractor” discusses Allstate’s latest tactics, which reflect what I have been telling you the last few months. One advantage we both have is that I speak to doctors nationwide on a daily basis, and share with you what is happening before the industry reports it in 2-3 months. You have an edge. Here is the next area of concern…
Over the past year, I have read countless SOAP notes as well as evaluation reports to see if the services rendered matched the doctor’s orders in the evaluation reports. The results are mixed; I would like to say most did well, but that’s not the truth.
The latest tactic utilized by the plaintiff is to request 50 (or whatever # they want) non-PI charts from the doctor to see if the standard of the note is the same for all financial classes (with a court order to supersede confidentiality). The unsuspecting doctor submits the notes and what is found in many cases, is that the standard of the note for the cash patient is quite different from the standard of the note for the PI patient.
This is problematic from a licensure perspective. This is one way for the plaintiff to “back door” the doctor in rendering a complaint against the doctor’s license to a state licensure board. They can use this to prevail in their case, as the doctor who practices in this paradigm can have this used against them in court. The doctor will lose if the paperwork confirms this allegation. Should there not be a court case, a licensure board, upon request, can review the doctor's notes without a court order and the same result will follow. The doctor will be looking for a job at Walmart, should his/her resume be strong enough!
Make sure you have the same standard of care for every patient, inclusive of your evaluations and SOAP notes. There are no exceptions!
As a result of many doctors being concerned about the quality of their paperwork and potentially having to defend themselves, I have spent the last few months working with another compliance specialist to create a solution where collectively, we have 60 years of experience. Together we are creating a service that will accept 5 to 10 of your charts and give you a "compliance review" or "check-up" on your practice’s paperwork to ensure that you compliantly document your services. We will score your paperwork and render a compliance quotient with a detailed analysis of your practice. This includes that the treatment rendered clinically correlates to the evaluation findings, diagnosis, tests ordered, treatment orders and treatment rendered to your billing. We will work both with the federal and accepted standards of the chiropractic community.
The compliance review is based upon audits done by both the federal government and the insurers when deciding if a doctor has areas in their practice that are non-compliant. We have recently worked together on a case and have analyzed what the insurance industry is looking for in determining the weaknesses in a doctor’s practice.
This compliance program will also give you detailed recommendations on how to remedy any potential problems and will be absolutely confidential. We are also available to work with your legal counsel, should that need arise.
I will let you know when this service is available. I urge everyone, in light of the aggressive environment of the insurance industry to get their money back, to participate and get your practice’s compliance score.