Category: Legal Department

If you are a provider under a Preferred Provider Organization plan, you may be losing tens of thousands of dollars to which you are entitled. There is a scam occurring throughout the country, called the “Silent PPO”, which is costing doctors a lot of money and creating a financial windfall for certain unscrupulous insurance companies and brokers. It works as follows:

Your patient, Mrs. Jones, who is covered by Shady Insurance Company, is treated by you. You bill Shady for 80 percent of the bill and collect the 20 percent co-pay from Mrs. Jones. Shady asks a discount broker to find out whether you are a party to any PPO contracts. The broker learns that you are a provider for Crooked PPO. The broker buys your discount fee information from Crooked and sells the information to Shady. Shady sends you a discounted payment with an Explanation of Benefits, explaining that Mrs. Jones is entitled to the PPO discount; or, in certain cases, Shady will contact Crooked and Crooked will submit a discounted payment to you, claiming Mrs. Jones as its own enrollee.

Your billing department accepts the discounted payment because, although it can verify whether Mrs. Jones is a member of the PPO, it cannot as easily verify whether Shady belongs to the PPO and is, therefore, entitled to the discount. You lose money, because you should have been paid the full 80 percent for Mrs. Jones’ bill, not the discounted amount.

The parties making money on your labor are Shady, because it pays less on the claim than it should; Crooked, because it gets paid either by the broker, for selling the discount information to the broker, or by Shady, for processing the claim on Shady’s behalf; and the broker, who gets paid for supplying Shady with your PPO information. One way to avoid this problem is by being very careful when you enter into a PPO agreement. Determine whether the PPO is reputable before you sign anything.

The following characteristics are generally indicative of a legitimate PPO:

1. The contract provides for the following in writing:
  a. Provider directories are current.
  b. Provider directories are made available to you before you sign the contract.
  c. The directories are updated quarterly.
  d. You receive a list of payers at contract signing.
  e. You receive a list of payers before you are required to give a discount.
  f. You receive an updated list of payers on a regular basis.
  g. You have permission to approve new payers—if you do not approve of the new payers you may opt out of the contract with no penalty.
  h. Members have ID cards which identify the member, the PPO and the PPO telephone number in order to verify eligibility.

2. The PPO has a large staff nationwide. A large staff indicates that the PPO is concerned about both provider and customer relations. It should have about:
 a. One customer service employee per 3000 covered lives,
 b. One claims administration employee for every 3500 covered lives,
 c. One provider relations employee for every 1200 providers.

3. The PPO should credential providers according to set standards and practices. The process should take 60 to 90 days and should require re-credentialing at least every two years.

4. The PPO should have its own internal Utilization Management/Quality Assurance Program.

5. The PPO should present its fee schedule as the basis for negotiation.

6. The PPO should offer training and educational programs.

The following characteristics are generally indicative of a problem PPO:

1. The PPO does not have a payer list or will not give you one.

2. Payors identify themselves as PPO members via the EOB only after you have seen their members.

3. The PPO does not issue ID cards, will not provide you with a specimen card (or refer to it in your agreement), and has no eligibility verification hotline.

4. The PPO has a small staff (This is almost an immediate give-away that the PPO has been set up to resell provider numbers).

5. The PPO does not credential its providers.

6. The PPO claims to have a national network, but contracts out all its Utilization Management and Quality Assistance functions.

7. The PPO does not have a fee schedule—it starts negotiations by asking how much of a discount you are willing to give.

8. The PPO is indifferent to the efficiency of your practice.

Reviewing the PPO contract for these items may be a bit time consuming initially, but will save you much money over the long run.

If you have any questions with regard to the above or with respect to any other legal heath care issues, you may FAX your questions to Deborah A. Green, Esq., at 954-971-3787 or call 954-971-7778 or e-mail [email protected]. In future issues, she will be answering those questions that are of interest to the broadest audience.

Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in the State of New York and Florida and is a member of the American Health Lawyers Association, the New York State Bar Association Health Care System Design Committee, the New York State Bar Association Health Care Providers Committee, the American Bar Association Health Law Section and the Florida Bar Health Law Section. She has formed numerous multi-discipline practices throughout the country.

Disclaimer

Because this column is being presented to you by an attorney, it would not be complete without a disclaimer. This column is provided subject to and governed expressly by the terms of this disclaimer. This column is provided for educational purposes only. The accuracy or timeliness of the information presented herein is not warranted. The information presented herein is not intended to be advice as to a specific fact pattern with which you may be presented.  Accordingly, please note that the information contained herein is not being presented as legal advice with respect to any matter and that no attorney-client relationship is hereby established.

In 1999, Dr. Joseph purchased a hydro therapy modality table, commonly known as a hydrobed, a water based massaging device which is more or less a bed upon which a patient lies for treatment. There being no specific current procedural terminology code for this modality, the manufacturer recommends the use of one of three plausible codes: 97022 (whirlpool); 97214 (massage); or 97139 (unspecified procedure). Dr. Joseph, realizing that insurance companies reimburse 97022 (whirlpool) at a slightly higher rate than the others, uses the whirlpool code for billing purposes throughout 2003, never bothering to contact his chiropractic board or the insurance companies to get an opinion as to the proper code for use.

In 2001-02, the American Chiropractic Association, acknowledging confusion in the industry as to the proper coding for hydrobed therapy, issues a position statement suggesting that the proper code to use for billing purposes is 97139 (unspecified procedure).  Unfortunately, Dr. Joseph never is made aware of the ACA’s position statement until after being criminally indicted for, among other things, coding hydrobed therapy as 97022 (whirlpool) from 1999 to 2003. 

Guilty or not guilty?

Dr. Joseph is found guilty of mail fraud in coding hydrobed therapy as 97022 (whirlpool) from 2001 through 2003.  His defense of plausible interpretation of an ambiguous billing code is refuted by his choice of a code for greater financial gain in the face of industry recommendation of a preferable code that reimbursed at a lower rate.

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address, www.leconomoslaw.com, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.

Benefits of the Multi-discipline Practice

The multi-discipline practice eliminates the delay that occurs when a patient needs to travel to various locations to see different doctors. I am certain that there have been occasions when the patient you were treating required medical treatment. Accordingly, you referred that patient to a medical doctor. In some instances, the patient returned to you; in other instances, the patient was lost for good. In all instances, the patient was put to the inconvenience of having to make an additional appointment at another location for treatment. You and the medical doctor lost valuable time and energy playing telephone tag, and the patient lost days waiting for the new appointment when he could have been recovering.

Learn to think out of the chiropractic box. The multi-discipline practice is limited in the services that it can render only by your imagination and the ability of the practice’s providers. The services that may be offered are vast.  Do not treat the multi-discipline practice as an overgrown chiropractic practice—that is not its function.

Protocols of the Multi-Discipline Practice

In all instances there must be a medical director who is a licensed medical physician who makes all medical decisions. The medical director is employed by a medical Professional Entity in those states where the corporate practice of medicine doctrine (“the Doctrine”) is in effect; or, as discussed in an earlier issue of The American Chiropractor, in those states where the Doctrine is not in effect, the medical doctor is employed by a general business entity, such as an entity or limited liability company (“LLC”). The practice may employ chiropractors, physical therapists, acupuncturists, phlebotomists, nurse practitioners, physician assistants, and various other types of health care providers.

Corporate Compliance

The various entities need to have a series of agreements which describe the duties and obligations of each entity to the other.

After the entities have been formed and the legal documentation signed, you are required to maintain the corporate existence of all three companies. Limited personal liability and the tax benefits of doing business in the corporate form are available only when you comply with the requirements of corporate law.

The benefits of corporate operation flow from the legal recognition of the entity as an entity separate from its individual shareholders, directors and officers. To enjoy these benefits, you must operate the entity as a separate entity and in accordance with certain formal requirements.

It is essential that corporate and personal affairs be kept separate. Never mix corporate and personal funds, assets, or accounts. Do not use corporate funds or assets for personal or for another business’s use. Business should be done in the corporate name. Avoid any indication that you are dealing in a personal capacity. The corporate name should be used on the telephone, advertisements, letterheads, cards, signs, etc.

When signing documents, it should always be made clear that you are acting on behalf of the entity.

In keeping with the recognition of the entity as a separate legal entity, the formalities of corporate operation provide the mechanism by which the entity governs itself, makes decisions, and takes action. Properly held meetings of shareholders and directors are the key to formal operation. The courts consider observance of the formalities as important evidence in deciding whether or not the entity has been operated as a separate entity. The formalities are often the source of authority for those who act on behalf of the entity. Officers, directors and employees who act without authority (that is, without the proper approval of the shareholders or the directors, properly made and recorded in the corporate minutes) may be personally liable for their acts.

Initial Steps to Forming a Multi-Discipline Practice:

1. Review your lease with respect to prohibitions against sub-letting. Many leases contain clauses that prevent an existing tenant from sub-letting its space to another entity. In such a case, an addendum to your existing lease will have to be negotiated with your landlord. Your landlord may require additional security, a personal guaranty or a lump sum payment to permit you to sublet the premises to the management company (which will, then, further sublet to the Professional Entity). Make certain that you obtain the landlord’s permission for successive sub-lets in writing. You will also need to get written permission from your landlord to make the appropriate structural changes, if necessary.

2. In the event that you maintain a home office, you need to determine whether you are permitted to sublet to a third party.

3. You may wish to sell your patient list to the Professional Entity and your equipment to the Management Company. In that event, you will need to obtain a fair market value appraisal of both your patient list and equipment.

4. Retain the services of a qualified consulting firm. Before you retain such a consulting service, make sure that the firm has not been excluded by Medicare/Medicaid. You should also price the services and ask for (and follow up on) references. The first year of managing a multi-discipline practice can be very confusing. You are learning brand new procedures, and there will be an intense learning curve. Although you will require a competent lawyer to prepare your documentation, he or she is neither a coding and billing expert nor a clinician, and will probably be unqualified to provide you with all the information that you will need. In most instances, your consulting agreement should not be longer than one year. Your learning curve is steepest in the beginning—by your tenth month, you should be comfortable with what you are doing.  The eleventh and twelfth month should be for streamlining the process.

5. Bear in mind that, in most cases, your consultant is not an attorney—if you have any legal questions, ask your lawyer. Your consultant is not legally permitted to provide legal advice to you—even  if he or she does, you are not permitted to rely upon it. If something seems too good to be true, it generally is—seek professional help.

6. Consider implementing a compliance program into your practice. View it like a form of preventive care that protects against fraudulent or erroneous conduct. Compliance programs are internal controls and procedures that promote adherence to federal, state, and private health care programs and requirements that help you run your practice legally.

7. Review the existing policies and procedures currently in effect in your office. Make certain that they are appropriate to a multi-discipline practice. Make certain that all policies are written and that they are lawful. I have seen some personnel policies that violate almost every right guaranteed by the United States Constitution. Be sure that yours will not expose you to liability.

8. Make sure that you retain a qualified health care lawyer.

If you have any questions with regard to the above or with respect to any other legal heath care issues, you may FAX your questions to Deborah A. Green, Esq., at 954-971-3787 or call 954-971-7778 or e-mail [email protected]. In future issues, she will be answering those questions that are of interest to the broadest audience.

Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in the State of New York and Florida and is a member of the American Health Lawyers Association, the New York State Bar Association Health Care System Design Committee, the New York State Bar Association Health Care Providers Committee, the American Bar Association Health Law Section and the Florida Bar Health Law Section. She has formed numerous multi-discipline practices throughout the country.

DISCLAIMER

Because this column is being presented to you by an attorney, it would not be complete without a disclaimer. This column is provided subject to and governed expressly by the terms of this disclaimer. This column is provided for educational purposes only. The accuracy or timeliness of the information presented herein is not warranted. The information presented herein is not intended to be advice as to a specific fact pattern with which you may be presented.  Accordingly, please note that the information contained herein is not being presented as legal advice with respect to any matter and that no attorney-client relationship is hereby established.

If done correctly, the multi-discipline practice is completely legal and will most likely have a longer life than the stand-alone chiropractic practice.

The reasons are simple. At one time, many states followed the corporate practice of medicine doctrine (the “Doctrine”). The Doctrine held that only a medical doctor was allowed to own shares in a corporation that rendered medical services. Today, more and more states are permitting allied health care practitioners to form professional entities together; this means that a chiropractor and a medical doctor may become shareholders in the same entity. Other states are eliminating the Doctrine entirely. In those states where the Doctrine has been eliminated, anyone may own an entity which renders medical care. The entity must, however, employ a medical physician who is responsible for making all medical decisions. The owner of the entity may have no input with respect to any medical decision concerning any patient unless she/he is a medical doctor or an osteopathic physician (hereinafter, “M.D.”) herself/himself.

Investigate Your State Laws

There are various sub-categories of the Doctrine in those states which still recognize it. Some states permit a chiropractor to hold shares in a medical professional entity, so long as an M.D. is also a shareholder; some states require that, in such a case, the M.D. hold a majority of shares, because the M.D. holds a plenary license whereas a chiropractor holds a limited license; other states require that the name of the entity not contain the word “medical” or “medicine” when a non M.D. owns shares in the entity, while other states consider the use of the word “medicine” or “medical” mandatory. Some states still do not permit anyone other than an M.D. to own shares in an entity which renders medical services. It is very important to ascertain what the status of the law is in your state with respect to the corporate practice of medicine Doctrine. Failure to comply with the Doctrine could result in contracts being declared void, loss of professional licensing, injunction against the practice’s business operation and a myriad of other sanctions.

Precautions in Billing

Regardless of what the law is in your state, you must be extremely careful in the way that services are billed. Never use the name and/or billing number of an M.D./D.O. who is not physically on the premises when a service is performed, except under very narrow circumstances. “Standing orders” (a situation where the M.D. sees patients once a month for a few hours and writes a “prescription” for chiropractic adjustments which are then performed by the DC but are billed in the name and number of the M.D., as if the M.D. were physically on the premises) should be avoided entirely. It is false billing and might land you in jail.

Setting up a Multi-disciplinary Practice

Establishing a multi-discipline practice owned by a chiropractor, in those states which have eliminated the Doctrine, is relatively simple. A single entity is formed, which is owned by the chiropractor. This entity enters into employment agreements with its employees, such as the M.D., nurse practitioner, chiropractor, physician assistant, and so on. Care must be taken that each health care practitioner renders services within the scope of his practice. The best way of ensuring this is to be familiar with the scope of practice of each practitioner that is hired.

In order to comply with the law of those states which uphold the Doctrine, certain contracts must be entered into by various entities. I recommend that three entities be formed:  A Management Company, a Professional Entity, and a Funding Company.

The following is an explanation, in a nutshell, of the interaction among the medical entity which is owned either solely by an M.D. or by both an M.D. and the chiropractor (the “Professional Entity”), a management company which is owned solely by the chiropractor (the “Management Company”) and a funding company which is also owned solely by the chiropractor (the “Funding Company”).

The Management Company

The Management Company charges a fee for every act and/or service that it performs on the Professional Entity’s behalf (e.g., all clerical duties, equipment rental, lease rental, etc.), pursuant to the terms of the Management Agreement in which it enters with the Professional Entity. The charges must be at a fair market value rate (value added if applicable), which is a set fee (under no circumstances should it be a percentage, as many states consider the payment of a percentage to the management company by the Professional Entity to be fee splitting), and payable regardless of whether the Professional Entity is actually paid for its services. Your accountant can help you determine the fair market value applicable to your area.

Caveat: Many doctors have found themselves in trouble because they did not treat the Management Company like an actual business. It is vital that you be familiar with all the terms of the Management Agreement and that you abide by them. You may no longer think of yourself as just a chiropractor—you are also the president of the Management Company and you must run that business properly.

The Medical Professional Entity

The shares of the medical professional entity  (“Professional Entity”) are owned by an M.D. (and, where permitted, also by the chiropractor). The chiropractor is named as Secretary of the Professional Entity for purposes of administrative convenience only. Under no circumstances may the chiropractor exercise control over any medical issues, which are left strictly in the purview of the M.D., who will also be the medical director of the Professional Entity.

The Professional Entity may employ various licensed health care professionals, such as physicians, physical therapists, chiropractors, etc., to render services to the Professional Entity’s patients. Each such health care professional enters into a written employment agreement for a term of no less than one year with the Professional Entity. Payment to each such health care professional is at a fair market value rate. Fair market value is determined by the going rate for such health care professionals in your community.

The Funding Company

The Funding Company is funded by you, personally. The Funding Company then provides a loan to the Professional Entity for any and all working capital requirements that the Professional Entity may have, e.g., the purchase of equipment, salaries, lease payments, management fees, taxes, your practice, etc. The Funding Company is repaid by the Professional Entity (interest only). The interest is paid to the Funding Company monthly. The principal amount is due on demand. In order to secure its loan, the Funding Company receives a Note and a lien on all accounts receivables and other assets from the Professional Entity, in addition to other security.

Caveat: The Funding Company will protect your investment in the event that the M.D. working in your practice gets divorced, dies, or goes bankrupt. Do not ignore this company—make sure that you use it properly. If you do not understand the reason for its existence, make sure that your lawyer explains it to you in detail.

If you have any questions with regard to the above or with respect to any other legal heath care issues, you may FAX your questions to Deborah A. Green, Esq., at 954-971-3787 or call 954-971-7778 or e-mail [email protected]. In future issues, she will be answering those questions which are of interest to the broadest audience.

Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in the State of New York and Florida and is a member of the American Health Lawyers Association, the New York State Bar Association Health Care System Design Committee, the New York State Bar Association Health Care Providers Committee, the American Bar Association Health Law Section and the Florida Bar Health Law Section. She has formed numerous multi-discipline practices throughout the country.

DISCLAIMER

Because this column is being presented to you by an attorney, it would not be complete without a disclaimer. This column is provided subject to and governed expressly by the terms of this disclaimer. This column is provided for educational purposes only. The accuracy or timeliness of the information presented herein is not warranted. The information presented herein is not intended to be advice as to a specific fact pattern with which you may be presented.  Accordingly, please note that the information contained herein is not being presented as legal advice with respect to any matter and that no attorney-client relationship is hereby established.

The most obvious answer is don’t engage in intentional fraudulent schemes involving claim submissions to Medicare or private insurance programs seeking more compensation than you would otherwise be entitled. Keep in mind that, despite the fearsome issue of honest billing errors leading to criminal investigations, most criminal investigations stem from fraudulent conduct that is reported by an employee, third party, or an insurance program, itself. Health care fraud is a national problem that passes loss onto consumers in the form of higher premiums and poorer economic output.  Bear in mind that facts used to illustrate previous points in earlier articles are fictional and not to be confused with actual criminal cases or intended to suggest the guilt or innocence of any actual defendant.  United States prosecutors and investigators are honorable and discharge their responsibilities ably and well. Qualified defense attorneys perform equally well, but the rubber meets the road with the age old adage, “If you can’t do the time, don’t do the crime.”

And for those sailing with an ethical compass, but with a sloppy, poorly trained crew, don’t despair. Four words will help get you back in command and set your ship aright: Health care compliance audit. There’s nothing magical to this. No short cuts and no sweeping stuff under the rug. If you have a dirty kitchen, you either clean it up or it stays dirty. The answer to cleaning up sloppy billing procedures is no different. Just do it.

Where do you find these amazing problem solvers? From referrals from others; from trade journals and the Internet. But a word of caution: Check the resume. An unqualified person is going to do this job poorly and leave you with false security. Health care laws are complex. Folks make a living out of figuring them out. Proper health care billing, in all respects, requires a breadth of knowledge of various matters, from CMS regulations governing Medicare, to criminal codes, to private insurance program policies, to CPT terminology and industry interpretations, to common understandings of ordinary and customary billing practices.

After your compliance audit is completed, conduct an interview with the auditor; find out where your danger spots are and make corrections as advised. Then, schedule a tune up on a periodic basis to make sure time, and the laws are not passing you by. Be good to your practice and it will be good to you.

The other thing you can do is to take an inventory of your crew. If you started out from Bermuda, charted a course to the Bahamas, and ended up in Iceland, chances are that, no matter how much you know about sailing, something’s going awry when you’re not in the cockpit. If it’s not the boat itself, then, well, the source of the problem should be pretty obvious. If you have unqualified employees in positions of responsibility, requiring them to code medical procedures, fill out HFCA claim forms, interpret your handwriting on medical records, even type in input for your computer billing program, then you have a problem akin to a gambling addiction without any upside chance of ever hitting it big. You may as well spend your time painting placards that say,”I am innocent!” and march in circles around the nearest courthouse. In fact, there comes a point when recklessness creeps awfully close to deserving what one gets. Don’t be reckless. Don’t try to save expenses by hiring undereducated, under qualified wonder kids, expecting them to figure everything out for pennies to the dollar. If you have unqualified folks doing your billing, let them go.  If you don’t have any, just say, “No.”

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address, www.leconomoslaw.com, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.

While some of the warning signs of a potential health care fraud investigation are obvious, others are not.  Consider the obvious ones to be flashing red lights signaling you to stop and make sure you can move in safety before starting again.  The less obvious warning signs are cautionary, yellow lights signaling you to slow down and proceed with care.  Both require attention. 

The obvious signs have one thing in common: The insurance company.  They are fourfold in increasing order of severity:

1.  A billed health insurance company notifies you of an internal audit indicating unusual billing errors;
2.  Representatives of a billed health insurance company ask that you submit billing records for their review;
3.  Representatives of a billed insurance company come to your office asking to review records; and
4.  A billed health insurance company demands that you pay back a significant amount of money for alleged improper billing. 

Signs 1 and 2 demand that you stop conducting business as usual and conduct your own internal audit of treatment records and submitted bills.  Have an attorney involved to make certain your audit remains private and privileged.  Discover your own errors and implement corrective measures.  Allow a qualified health care fraud defense attorney to represent you in all correspondence and dealings with the insurance company.

If you’ve handled signs 1 and 2 properly, signs 3 and 4 may never appear.  If they do, you have laid a foundation to establish your innocence due to billing errors rather than to intentional acts of fraud.  The less obvious warning signs are threefold:

1.  Word gets around that a disgruntled employee is threatening retaliation;
2.  An employee notifies you that insurance claims have been submitted with significant billing errors; and
3.  Either you or a partner keeps scanty treatment records, often not fully documenting all your services.

When any of these signs appear, implement an internal review of your billing practices.  Scrutinize some randomly selected submitted claims for billing errors, however small, and implement corrections for future submissions.  Begin proper treatment documentation.  If significant billing errors are found or suspected, consider yourself seeing a flashing red light and proceed to implement corrective measures, as outlined above, for obvious warning signs 1 and 2.

Final word of caution: Make certain that your attorney is qualified and experienced in health care fraud defense.  Regardless of their experience level in criminal defense, health care fraud is a specialized area that requires experience and knowledge in Health Care Financing Administration (HCFA) 1500 form billing, Medicare laws, state and federal criminal law, private insurance company adoption of billing regulations, contractual notice, Continuous Performance Tests (CPT) chiropractic coding, incidental billing practices, as well as customary health care billing practices.  Not many attorneys have this experience.  Ask about prior experience, including past contacts with qualified medical billing compliance officers.  Don’t be a lawyer’s guinea pig.

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address, www.leconomoslaw.com, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.

The answer is four fold in order of importance:

1)  Maintain good records;
2)  On some periodic basis, voluntarily submit to a health  care billing compliance audit conducted by a qualified compliance officer;
3) Associate with qualified office staff;    
4) Maintain professional relationships with all employees and medical associates.

Sounds easy, but it’s not.  Like a diet, the rules are simple, but often difficult to apply over the long haul.  Insulating oneself from criminal investigations in the midst of increasingly aggressive but wrong-headed prosecutions requires a no-excuses approach that measures success against a negative outcome.  In other words, it works, if you don’t get targeted for investigation.  But, without being targeted, you’ll never know whether all your efforts ever prevented a single investigation.  So, you might wonder, with no way to ever truly measure the success of your labors, why make any efforts?  Well, because there are side benefits to these basic efforts that will streamline your practice and make it more efficient and successful.  You will become a more disciplined and better professional.  And you will make more money.

1. Maintaining good records is more than employing a good office manager.  It means you must document, document, document.  These are the three “D’s”; forget about the others.  Discipline yourself so that, when in doubt, you  document.  Strive to reach the point in your practice where documenting your services—treatment, history, or mental notes—becomes as second nature as thinking about your patients’ problems.  Simply put: More is better; less is worse.  There are untold numbers of chiropractors who were either targeted or had investigations go haywire because of failing to properly document their treatment records.  And it’s good for your practice.  It provides you and others an ever-ready road map for efficient treatment.  It insulates you from complaints, no matter the origin—a patient, insurance company, employee, or cop.  And, don’t forget a back up to the records.  You need to put these records on disc every so often, in the event of fire or other damage.

2. Once every year or so, submit to a voluntary health care billing audit.  There are qualified personnel across the country, individuals who will come into your office and provide you with a business physical.  It’s no more discomforting than submitting to a urine or blood sample.  After a day or so, it’ll be over.  The cost isn’t so bad.  You will get a written report of some type.  Hire an attorney to maintain the reports for you so that any identified problems will remain private and privileged.  Read the report and implement at least some of the suggestions.  There is no better defense to the prevention of bad stuff.  It’s like taking a flu shot.

3. Do not associate with unqualified medical personnel,  at your office or elsewhere.  Of course, it may take some time to discover.  If so, once it becomes known, remove yourself from the situation, whether by firing, hiring, or fleeing.  Guilt by association is alive and well in health care fraud prosecutions.  One can  be  both courteous and firm when it comes to protecting a career.  Protect yours.

4. Finally, maintain professional relationships with employees and medical associates.  This means more than simply smiling and saying good morning.  Do not become involved in a side business deal or investment interest with any such person.  Limit your business deals with employees and medical associates to those involving your chiropractic practice. Play the stock market with someone else.  Invest in someone else’s real estate venture.  And, if a business arrangement limited to your chiropractic practice sounds too good to be true, well, it probably is.  So get some professional advice before you do it.  It’s better to pay a few hundred dollars now, to make sure everything’s on the up and up, than to struggle later trying to pay attorneys to fix problems you could never imagine were even possible.

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address, www.leconomoslaw.com, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.