Yellow Pages – Page 5 – The American Chiropractor

PIP: Scott ‘Arm Bending’ Works in Florida

Tallahasse, FL Gov. Rick Scott scored a huge victory when the Florida Senate signed off on a last-ditch effort to crack down on personal injury protection fraud.

But the vote elicited rebukes from some senators who wanted the upper chamber to stand its ground and refuse to concur with the proposal – crafted largely by insurance industry lobbyists – in a debate highlighted by a stemwinder by Sen. Miguel Diaz de la Portilla, R-Miami.

Diaz de la Portilla, a lawyer, repeatedly called the deal a “phoney baloney” attempt to combat fraud. Diaz de la Portilla had convinced the Senate in its version of the PIP reform to keep intact “multipliers” allowing lawyers to be paid escalated fees. The compromise did away with that but, in a concession to the Senate, did not cap attorneys’ fees or set an hourly rate.

Growing more incensed as his rant went on, Diaz de la Portilla said that PIP scams aren’t the real fraud.

“I think the House measure that’s been sent over to us and that we’re being asked to concede to, that’s the fraud. It’s a fraud on the consumers of the state of Florida. It’s a fraud on the people who have to buy these policies by law. It’s a fraud on those who are injured in accidents. It’s a fraud because it basically is the Insurance Company Relief Act of 2012. That’s what it is. That’s exactly what we’re talking about,” Diaz de la Portilla said

Sen. Dennis Jones, a Seminole chiropractor who said he is probably the only senator who actually treated a PIP patient, called the bill a “very, very punitive” measure for chiropractors. Patients will now be limited to $2,500 worth of chiropractic treatment, a change from the 24 visits over three months now allowed.

Sen. Joe Negron, the Stuart Republican who brokered the deal for the Senate and sponsored the chamber’s trial lawyer-friendlier proposal, rejected his colleague’s criticism that the Senate would be giving up too much by taking the House offer. Negron then defended his efforts to keep chiropractors in the mix at all.

“The House wanted to take chiropractors, tie two 50-pound cement blocks to their ankles and drop them over the boat into the bottom of the ocean. And they were never going to be heard from in PIP again. I found that very offensive,” Negron, a lawyer, said.

Chief Financial Officer Jeff Atwater, a former Senate president who pushed alongside Scott for the overhaul, called Senate critics “dead wrong” about the deal.“The Senate got all its fraud language. The Senate got all its licensure language. The Senate got room for chiropractic care. The Senate did not cap attorneys fees. The Senate did a fine job. The House was very firm on driving the cost drivers of utilization down. They came together with a really solid compromise,” Atwater said.

Atwater said he’s certain premiums will decrease although the bill does not require it.

“I think they’re going to see when that independent study comes down that they’re going to indicate rates need to be coming down. They need to come down now,” he said.

Allstate Seeking $2M in Accidental Payments in “Consumer Protection” Measure

HAUPPAUGE, N.Y., — Allstate Insurance Company has filed its first insurance fraud lawsuit of 2012, seeking to recover $2 million dollars against 27 New York area defendants. The Complaint names multiple physicians, chiropractors, medical professional corporations, and clinic lay-owners allegedly used to control the medical professional corporations, including 18 individual defendants currently under federal indictment.

The complaint alleges that New York medical professional corporations known as St. John Medical Care, P.C., Lenox Wellcare Medical, P.C., CB Chiropractic, LLC, New Age Orthopedic Rehabilitation, P.C., First Aid Medical Care, P.C., Rosedale Medical, P.C., TDL Medical, P.C., LDT Medical, P.C., and West End Chiropractic, P.C., were fraudulently incorporated through a scheme using the names of licensed medical physicians and chiropractors, and that lay-owners, none of whom were physicians, secretly owned and controlled the professional corporations.

The lawsuit was filed following an investigation by Allstate’s Special Investigative Unit and seeks reimbursement for no–fault benefits Allstate paid on behalf of its customers during timeframes specified in the lawsuit. The lawsuit is the latest in a string of actions taken by the insurer to protect consumers from these and similar activities. Since 2003, Allstate has filed 37 fraud lawsuits in New York State seeking more than $ 201 million in damages.

According to the Insurance Information Institute, the state of New York is in an insurance fraud crisis and no-fault fraud is costing New Yorkers millions of dollars year-after-year in higher premiums. “In essence, honest, hardworking New Yorkers are paying a ‘fraud tax,'” said Krista Conte, spokesperson for Allstate’s New York office. “We need lawmakers to enact meaningful insurance reform that puts the citizens of New York first.”

Source: PR Newswire

Republican Presidential Nominee Hopeful Rick Santorum’s Wife Wins $250,000 Lawsuit for “Chiropractic Induced Disc Herniation” While Santorum Trumpets Medical Malpractice Caps

On the campaign trail, GOP presidential candidate Rick Santorum says he will push to limit payments to victims in medical malpractice lawsuits, which he blames for unnecessarily driving up health-care costs. And over the course of his two decades in politics, he repeatedly spoke in favor of capping such awards.

But Santorum testified in support of his wife when she filed a medical malpractice suit in 1999 that sought $500,000, twice the cap in his 1994 legislative proposal. Karen Santorum claimed that a Fairfax chiropractor had left her with a permanent back injury that probably would result in a lifetime of pain medication and restricted mobility.

This fall, while campaigning in Iowa, Santorum told reporters that he backed some limits but that his wife did not sue for “pain and suffering, which is the area I think we should cap.”

Although the lawsuit did not seek a specific figure for pain and suffering, the former senator testified in the case about the emotional and physical toll on his wife and how that justified a sizable monetary award, transcripts show. The judge in the case also made clear that the majority of the $350,000 the jury awarded the family was largely for unspecific losses and pain and suffering, an amount he concluded was “excessive.”

The lawsuit stemmed from a family tragedy, when in 1996 Karen Santorum gave birth prematurely to the couple’s fourth child, a son who died the same day. Suffering lower-back pain after the delivery, Karen Santorum sought out a Burke chiropractor, David Dolberg, for help.

Dolberg performed a spinal manipulation, which he and other experts testified was a standard, recommended therapy for her symptoms. Karen Santorum said that the treatment caused a herniated disk in her spine, which was surgically removed a week later.

Brewster Rawls, Dolberg’s attorney in the suit, defended his client. “The medical evidence was clear that Mrs. Santorum suffered no serious injury,” Rawls said. “Quite simply, the outcome of this case — even with the trial court reducing the verdict by 50 percent — was entirely unfair to this good doctor.”

The Santorums unsuccessfully sought to seal the records in the lawsuit against Dolberg and the center where he worked, saying her husband’s role as a senator would draw attention to the case and violate his wife’s privacy.

Source: Washington Post

Non-Chiropractor Running a Florida Chiropractic Clinic Charged with Stealing 550k in False Health Insurance Claims

Ocoee, FL: An Ocoee man faces multiple felony charges in a suspected fraud scheme that authorities say bilked health insurance providers out of thousands of dollars in improper or phony claims.

An investigation by the state’s Department of Financial Services resulted in the arrest ofJean Ely Colin, who is identified in court documents as manager of Silver Star Health and Rehab Inc.

Investigators say Colin, 43, who court records state is not a licensed physician, conspired to get around state regulations requiring chiropractic clinics to be operated by a licensed doctor.

He listed a licensed chiropractor, Judith C. McKenzie, in incorporating documents as the clinic’s owner, but investigators say she wasn’t involved in day-to-day operations or management.

Rather, the business on Silver Star Road was run by Colin and co-defendant Marc Maxis, investigators said. According to court records, McKenzie had similar arrangements at other clinics.

A clinic employee also told DFS investigators that Colin often told him to falsify various documents and patient records, generating reports for patients that were not treated by the clinic.

According to court documents, the clinic improperly billed various major insurance companies, including State Farm, Allstate, Farmers and Progressive, to the tune of more than $550,000.

Colin faces charges of organized scheme to defraud, operating an unlicensed health care clinic, false and fraudulent insurance claims and grand theft. All of the charges alleged are felonies.

Colin was arrested on a warrant Wednesday. He has since been released after posting bail.

Source: The Orlando Sentinel, Fla.

Chiropractor Pleads No Contest to Sex Abuse Charge

Bluffton, FL: A 57-year-old former Bluffton chiropractor has pleaded no contest to charges of sexual abuse of a minor in Florida and will face similar charges in South Carolina involving the same girl.

Raymond Anthony Delgado sexually abused the girl while she was staying with him during a summer vacation in Bluffton and during his visits to her family in St. Johns County, Fla., according to the Bluffton Police Department and the St. Johns County Sheriff’s Office.

He pleaded no contest Thursday to two of the 10 child sex charges, both felonies, filed against him in St. Johns County, according to Florida’s 7th Judicial Circuit Court.

He faces up to 25 years in prison, according to state attorney public information officer Klare Ly.

Those charges were filed after Delgado had already been jailed in St. Johns County on Sept. 3, 2010. Delgado, who was living in the Westbury Park neighborhood in Bluffton at the time, was arrested in Florida at a place he and the girl had agreed to meet, the St. Johns Sheriff’s Office has said.

Delgado would travel to St. Augustine to spend time with the girl and her father, but that “was a guise to continue sexually abusing and molesting the child,” according to a news release from the Florida court.

“The defendant took advantage of his relationship with a child who trusted him,” said Florida state attorney R.J. Larizza. “There are few — if any — crimes more sinister than that.”

Source: The Beaufort Gazette

Stay on Illegal State Chiropractic Board Actions ICA Files Suit in New Mexico Court of Appeals

Albequerque, NM: Acting on behalf of concerned members in New Mexico and out of concern for the integrity and credibility of the chiropractic profession at large, on December 21, 2011 the International Chiropractors Association (ICA) filed an extensive memorandum in support of a motion to stay what is being held to be illegal actions on the part of that state’s Board of Chiropractic Examiners. In its memorandum of explanation, ICA’s attorneys argued that it was important for the court to carefully consider the urgent issues of the letter of the law and the protection of both the public and chiropractic practitioners and prevent the “New Mexico Board of Chiropractic Examiners from implementing its new rule establishing an advanced practice formulary to include dangerous drugs and drugs to be administered by injection…and implementing its new rules establishing a certain course of training to certify advanced practice chiropractic physicians to administer and prescribe dangerous drugs and drugs to be administered by injection” because such actions were outside their authority under the law.

On August 30, 2011, at an official rulemaking hearing and meeting, the New Mexico Chiropractic Board adopted new rules to greatly expand the chiropractic formulary to include certain dangerous drugs and drugs to be administered by injection that had not been approved by either the New Mexico Medical or Pharmacy Boards as specifically required by state law. At that same hearing, lawyers representing the State of New Mexico were very clear in their advice that the Board was acting outside their authority and should not proceed. The Chiropractic Board ignored those admonitions and acted to adopt a new formulary anyway.

ICA representatives were present at both the August and December Board meetings and, in concert with New Mexico DCs, urged the Board to act only within the rules established by statute but to no avail. At their meeting of December 13, 2011, the New Mexico Chiropractic Board denied all requests to stay the implementation of the new rules pending appeal. ICA received official documentation of the New Mexico Chiropractic Board’s official denial of a request to stay the controversial rules on January 5, 2012. Having exhausted all administrative remedies, ICA is seeking the protection of the courts in the face of the Board’s questionable actions.

ICA’s attorneys filed the extensive memorandum of December 21, 2011 to document the urgent need for a court-ordered stay to stop the inappropriate Board actions as the evidence shows that the New Mexico Chiropractic Board knowingly violated the terms of the law and citizens and practitioners alike are clearly at risk as a result.

ICA has taken this extraordinary step to help prevent a serious unraveling of public confidence in the chiropractic profession and severe damage to the credibility of the chiropractic regulatory process in New Mexico. “The public must have absolute confidence that the process of licensing and regulating the practice of chiropractic in all states has been undertaken with complete honesty and meticulous care to obey not only the letter but the spirit of the law as established by state legislatures,” said ICA President Dr. Gary L. Walsemann. “Regrettably, this does not appear to be the case with the current New Mexico Board of Chiropractic Examiners and action in the courts on ICA’s part was clearly the right thing to do.”

Source: Now You Know Newsletter

Sitka Clinic’s Medical Files Show up on the Internet

SITKA, AK: — A Sitka resident conducting an Internet search recently helped reveal that the personal information of more than 500 patients of a local chiropractor was available on the Web. Dr. Paul Beane, a chiropractor at the Sitka Wellness Center, told the Sentinel an “electronic medical record software vendor” he used for about nine months in 2008 had stored patient information, including names, dates of birth, social security numbers and addresses, on a Web server in an “unsecured text file” that was easily accessible. Beane said up to 566 of his patients had their information compromised, although Sitka police said there have not yet been any reports about suspicious activity that might be tied to the security breach.

He said he “recognized a lot of the names” on the patient list. The patient information has since been removed from the Web and Beane said he is working with Google to have it scrubbed from Internet archives as well. It is not clear how long the information was available on the Internet. Beane put the blame for the leak squarely on EMR4Doctors.com, a company Beane used when he switched to electronic records in April, 2008. “I’m absolutely furious that this happened,” Beane said.

Beane said he used the software provider from about April 2008 to January 2009, when he switched back to paper records. The company, which Beane said is registered in Nevada, apparently stopped doing business in 2009. A number for the company was disconnected, and there was no current listing for it in Las Vegas. Beane said he did not believe the records were posted intentionally, but called the security breach “sloppy and careless.” Allen said that until police receive a report about the information being used fraudulently, no criminal charges will be made. He said police would probably “package up” the information they have about the case and send it to the state attorney general in the next few days. “Until somebody uses the information it’s more of a civil issue,” Allen said. Beane, who is working with a lawyer in Pennsylvania, said he was “exploring his legal options,” which could include a civil lawsuit against the software vendor.

Source: The Anchorage Daily News

Chiropractors Discriminated Against for Doing Chiropractic

Phoenix, AZ: A group of chiropractors today called on Gov. Jan Brewer to fire the director of the Arizona Department of Insurance for not upholding a law they say requires insurance companies to cover chiropractic services.

Dr. Alan Immerman, president of the Arizona Chiropractic Association, claimed Insurance Director Christine Urias is “beholden” to insurance companies, particularly Blue Cross Blue Shield of Arizona, which pays $44 for a chiropractic visit no matter how much treatment is provided and requires the patient to make a $40 co-payment.

Immerman said the insurance company will then pay only $4 on the visit and then only allow six to seven visits no matter how bad off the patient is.

“Health insurance will pay fully for patients to get treatment for back and neck problems when they’re seen by medical and osteopathic doctors, but will pay next to nothing if the patient is seen by chiropractors,” Immerman said.

The result, Immerman said, is that hundreds of chiropractors are going out of business.

A call to Urias’ office was not immediately returned.

Regena Frieden, a Blue Cross Blue Shield spokeswoman, said in an email the company tries to maintain a balance between rising healthcare costs and coverage for services.

She said the company works with a vendor who contracts with 850 chiropractors that have agreed to accept its reimbursement rates.

Source: Arizona Capitol Times

Soap Star Sues Chiropractor

Los Angeles, CA: “She Won’t Crack My Back ‘Cause I’m a Scientology Reject”. “Young and the Restless” star Michael Fairman has filed a lawsuit against a Scientologist chiropractor — claiming she refused to see him and his family after he was excommunicated from the Church.

Fairman claims he was a prominent member of the Church, but became disenchanted with the way the Church was running things. Fairman claims Church leaders got fed up with him earlier this year, branded him and his wife “suppressive persons” and blacklisted the family from all things Scientology.

After Fairman was ousted, the actor claims he received a letter from the family chiropractor — an active Scientologist — informing him she would no longer treat the Fairman family. Fairman also claims she refused to hand over a copy of the family’s medical records.

In the lawsuit, Fairman claims he MUST have been discriminated against because he’s no longer with the Church — noting that he’s been a good, paying customer since 2003.

Source: TMZ

Expansion of Medicare Advantage Business Is One of WellPoint’s Biggest Ever

INDIANAPOLIS, IN – WellPoint affiliated plans are adding Medicare Advantage (MA) products in 136 counties in 11 states this year, encompassing a population of more than 1 million people eligible for Medicare.

MA plans incorporate Medicare Parts A (hospital) and B (medical) into one convenient product that may include additional benefits. Part D also can be added for drug coverage (MAPD). More than 12 million people across the country have a MA plan, according to America’s Health Insurance Plans.

“We’re very excited to get approval from the Centers for Medicaid & Medicare Services for this expansion, which is one of our biggest ever,” said Julie G. Smith, a vice president in WellPoint’s senior business. “These plans will help provide people eligible for Medicare with more choices for their health care within their respective markets.”

As a result of the expansion, Medicare eligibles in 74 counties in six states will have access to a WellPoint affiliated health plan for the very first time. The largest expansions to new counties are occurring in Georgia, Missouri, Virginia and Wisconsin. Premiums vary by geography, including some $0 premium plans. Additionally, people in many counties that were already served by WellPoint affiliated plans will have access to new products. For example, they may have access to a WellPoint local PPO or HMO plan for the very first time.

The products are being sold during the 2011 plan Annual Election Period (AEP), which runs from Oct. 15 to Dec. 7 this year, with an effective date of Jan. 1, 2012. Also during AEP, the WellPoint affiliated plans are offering Optional Supplemental Benefits (OSBs) in 12 states. OSBs cover additional services that may not be covered in the member’s Medicare Advantage health plan, such as dental, vision, chiropractic services and acupuncture. Medicare beneficiaries can enroll in an optional supplemental benefit package when they enroll in their 2012 MAPD or for up to 90 days after their plan effective date. OSBs require an additional premium.

“Baby Boomers are aging into Medicare with many interests and goals,” Smith said. “We’re developing products like OSBs to give them a variety of choices.”

In addition to MA and MAPD plans and OSBs, WellPoint affiliated plans offer Medicare Supplement plans with extra benefits available for purchase called “Anthem Extras.” Medicare has neither reviewed nor endorsed this information. Benefits and premium may change on January 1, 2013. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Source: WellPoint, Inc.