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Chiropractic Fraud – Perception and Reality

Is health care fraud more common than that offered by members of other health care disciplines in claims submitted by chiropractors? When looking at various sources of news, no spine therapists were found to have the largest share of health care fraud allegations or convictions.

Unfortunately, all health care disciplines are subject to fraud and abuse – chiropractic, medicine, physical therapy, and more. No single subject can claim a higher percentage of fraud than any other health care discipline. However, since this fact, insurance companies have been studying chiropractic treatments. These investigations are not just an assessment of the merits or medical necessity of a claim to determine whether it should be paid.

The insurance company is in the process of late payment ' auditing claims paid in the past few years – focusing on so-called file defects, in order to open the door for demand refunds for operators! Chiropractors found themselves facing large refunds from insurance companies. why?

Is it because there is no service? No, the insurance company verifies the performance of the service by talking to the patient. Is it because the masseur did not record the implementation of this service? No, problematic services are usually recorded as executed. Post-payment audits are generated because insurance companies have retrospectively [and sometimes based on a sense of rights] that the service is not adequately documented – that is, they are satisfied!

The insurance company asks the provider for a refund to pay – the allegation that the provider has not adequately recorded the service received – a complaint to the provider's licensing and regulatory committee. If such a complaint is filed, the real test will be that the documents and standards are not met. The document standards for health care providers and all other practices are developed and defined by the State Health Care Licensing and Regulatory Commission. The board of directors, not an insurance company or a managed medical institution, exercises administrative oversight of those who violate laws and regulations and sanctions the activities of the licensee.

Allstate Insurance has a clear prosecution policy, prosecuting chiropractors, accusing fraud, and issuing press releases during the New Year celebrations. News sources, including the Journal of Chiropractic Therapy, investigate or evaluate the factual basis of these litigations before or after the lock-in step is published, with little or no news to Allstate.

The news media and the public generally believe that if Allstate sues a health care provider and accuses fraud, the provider must engage in fraudulent activities. This necessarily means that Allstate believes that they and their insureds are both deceived by the provider's actions or actions. It must also mean that Allstate relies on the provider's false statement when paying the claim?

Well, according to the ruling of the US Fifth Circuit Court of Appeals in September 2007 on the Allstate Insurance Co. case, this is certainly not the case. v. Accounts Receivable Finance Company, LLC, etc. The court announced that Allstate is a major participant in the wounded affairs – when Allstate regularly reviews the health care bill submitted by the chiropractor, it evaluates the provider's bill for some form of use and ends up under Allstate's view of the bill. A large part of it is medically unnecessary or not properly recorded and does not require payment interpretation, paying a significantly reduced amount – Allstate can't come back later and sue the same provider claiming it was a scam by the same provider tricked.

According to my personal knowledge, there is no cooperation with an accident and injury chiropractor ["A&I"] in the case called Defender. In 1998, after the federal authorities implemented search warranties, I assisted A&I in implementing a health care compliance program designed to detect and correct any misconduct, fraud or fraud by the company and/or its healthcare provider. – Mainly a chiropractor. After A&I implemented the compliance program, the federal investigation was basically over.

The compliance program implemented by A&I includes an intensive internal audit, monitoring and reporting system to identify and correct any form of misconduct. The compliance program is widely publicized to insurance companies and others who are invited to report their concerns about suspected misconduct and/or clinic activities to the A&I Compliance Committee and the relevant chiropractors to properly address these issues.

Allstate is well aware of the implementation of A&I's compliance program, but as far as I know, I have never reported to Allstate any concerns about the compliance committee that Allstate has accused in its highly public litigation. It's worth noting that while other insurers are in a position similar to Allstate, they do report concerns and these concerns have been adequately addressed and corrected by insurance companies. Satisfy.

Although it is an integral part of the creation and implementation of the A&I compliance program, my only connection with Allstate was after the lawsuit was filed. The contact consulted with a lawyer's assistant at Allstate. The paralegal said that I had helped A&I complete its compliance program, and Allstate's lawyers wanted to talk to me. I have never talked to Allstate's lawyers. The only reason I didn't talk to Allstate lawyers was that Allstate's lawyer refused to serve me as a domestication program for the state's foreign witnesses.

This brings us to the Allstate lawsuit filed in the Federal Court of Dallas, Texas, in March 2008, Allstate et al. v. Michael K. Plambeck, DC, Chiropractic Strategies, etc. In this lawsuit, Allstate accused Plambeck of owning and operating the Chiropractic Strategy Group ["CSG"], planning a multi-state scam involving doctors, lawyers and telemarketers to provide free spine massage therapy for victims of car accidents. Assessment – Claiming that these free screenings are some form of trick that allows CSG doctors to "notify" their seriously injured patients and encourage them to enroll in a lawyer's legal agent to claim insurance claims and/or participate in litigation insurance against Allstate .

At a press conference on March 6, 2008, Allstate reported that it had filed a lawsuit against Plambeck after conducting an in-depth investigation into their special investigation department. Edward Moran, assistant vice president of Allstate, who is in charge of the special investigation department, was quoted as saying: "Insurance fraud is a billion-dollar business, and the average annual premium of $300 is increased… Allstate is actively promoting this fight. Oppose insurance fraud to protect consumers and help reduce insurance costs."

This must be the investigation of Allstate Special Investigator! For more than 10 years, Allstate has known how Dr. Plambeck conducts and operates his chiropractic clinic as described in his press release!

As a special agent of the National Insurance Crime Bureau [NICB], I and other investigative agencies – including Allstate – have been familiar with the specific behavior of so-called misconduct more than a decade ago. In fact, Allstate's complaints confirmed the return to activities in 1996.

No new content was found in the information published by [2008] – except that the average cost that insurance companies pass to insurance consumers has now risen to $300.00. This is an increase from the figures of $100 to $200 quoted in previous years.

Speaking of serious indignation, major casualty insurance companies often complain in the media that the high cost of delivery to the public is the result of medical fraud by chiropractors and other health care professionals. However, operators [if any] mention that they operate in luxury office buildings and pay millions of dollars to their executives.

For example, Allstate's CEO received an annual compensation plan worth more than $10.7 million in the first year of work, while the departing CEO received $18.8 million and $25.4 million in retirement benefits each year. Don't think that these costs will not be passed on to consumers in the form of interest rate hikes!

Allstate included a “call to action” in Plambeck's press release, which asked anyone who knew or had been sued in the spine medical industry to report this information to NICB. Why report this information to the NICB?

Is NICB a quasi-government law enforcement agency that assists Allstate in filing a civil lawsuit against Plambeck? Does NICB conduct a long-term contract criminal investigation of Plambeck's activities at the same time?

Under Section 501[c][4] of the Internal Revenue Code, NICB is a non-profit corporation that acts as a social welfare organization – through information analysis, forecasting, criminal investigations, and combating fraud and theft for consumer and public interest , training and public awareness.

I suspect that NICB will do what Allstate said. Allstate is one of its largest customers and funding sources! This will include helping them with civil cases because this is what they did in the above case. in…

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