Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 174

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.

“Compliance Alert”

I am working with the lawyers for a doctor who is fighting for his license. The insurance company reported a license violation to the chiropractic state board who, by regulation, requires an investigation. The lawyer first contacted me on July 15, 2010, so when reading this you will have a reference date. Upon first glance, the state board felt it was a credible complaint and hired an independent expert to critique the doctor’s files.

 

Here are the preliminary findings and subsequent formal complaints against the doctor:

1.  Treating without orders

2.  Treating undiagnosed areas

3.  Improper reporting of treatment

 

Let’s break it down.  First, treating without orders. The doctor failed to perform a re-evaluation in a timely basis. He did not perform a re-evaluation every 30-45 days and kept treating for 70-90 days successively. There were no update orders in the SOAP notes that could be construed as further treatment orders based on any clinical findings. Second, treating undiagnosed areas. The doctor treated the thoracic spine with no thoracic diagnosis or orders to adjust the thoracic spine. Third, improper reporting of treatment. When performing ultrasound, the doctor did not list the frequency settings that were applied to the patient.

 

This particular state is seeking to suspend the doctor’s license for 3 years as a result of these infractions. Fair or not, the doctor has hired a health care lawyer for $400 per hour to fight these charges and the lawyer reached out to me to support the doctor’s case. The doctor has to pay my fees as well. The final disposition of the case will not be had for a minimum of 1 year, maybe 2. Let’s be clear; the doctor has to pay a lawyer for 2 years over apparent minor issues.

 

These are not minor issues and I have been telling you that for years now. Reporting is serious stuff and the function of state boards are to protect the public. Your notes are critical in the care of patients which goes beyond the insurance company’s desire to find a wedge to get you to repay all of their fees. In protecting the public, if you treat undiagnosed areas, have you fully examined the treated area and concluded a diagnosis prior to delivering a high velocity thrust into the area? Have you documented the frequency of ultrasound correctly? What if the patient goes to another doctor because your ultrasound treatment hurt the patient and the new doctor does not know the frequency used and repeatedly hurts the patient. This could have been avoided if you documented the care you rendered.

 

These are issues state boards consider when reviewing charts and the current climate is to make examples out of offending doctors so that the message is clear to the rest of the doctors. State boards have limited resources due to budgetary cutbacks so that when the board gets a doctor to act upon, they are not as lenient as they once were (my personal opinion).

 

This particular doctor has one very big thing going for him. The carriers are looking at a 2006 case and the doctor voluntarily had a compliance audit in 2008. Since that time, the doctor’s attorney will be showing a progression of improvement in documented notes since the voluntary audit. Will that exonerate the doctor from the 2006 errors? No. However, it will potentially have the doctor placed on probation vs. losing his license for 3 years. That is the legal strategy. Time will tell what the final verdict will be.

 

The moral of the story is very simple:

1.  Evaluate your patients every 30-45 days

2.  Evaluate and diagnose every region you touch

3.  Document your care completely

4.  Get a voluntary compliance audit by faxing me your records to: 661-843-1062 

 

If you fail to plan, you plan to fail. Plan ahead, document well and practice with no fear.

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