Allstate, Liberty Mutual File $1M Lawsuit in Alleged Fraud Scam
KENTUCKY: June 26, 2003, Allstate Insurance Company and Liberty Mutual Group announced they jointly filed a federal RICO lawsuit against a Kentucky doctor and owners of several medical clinics and billing companies in that state.
The lawsuit seeks a declaration in regard to reimbursement of more than $1 million dollars for payments issued on behalf of policyholders by Allstate and Liberty Mutual Group companies, including Liberty Mutual Insurance Company, Employers Insurance of Wausau and Indiana Insurance Company.
Allstate and Liberty Mutual allege that the defendants formed and operated several medical clinics and billing companies in which excessive and unnecessary MRI’s and nerve tests were ordered. The suit contends that the defendants billed for those excessive medical tests and for services not rendered. The lawsuit also alleges the clinics and several mobile diagnostic operations established illegal fee-splitting agreements. The suit currently involves more than 900 Allstate personal injury protection claims, and 300 Liberty Mutual, Wausau and Indiana claims for personal injury protection, workers’ compensation and bodily injury.
www.insurancejournal.com
Chiropractor Penalized for Narcotics Problems
ILLINOIS: An investigation of a Rockford weight-loss clinic has come to a close, several years after the state accused the clinic of improperly buying and distributing narcotics for profit.
David Girgenti, a chiropractor, settled the case with the state in February. His chiropractic license was revoked for 45 days, from Feb. 20 to April 6. He was placed on a 30-month probation through Sept. 6, 2005. He also was fined $15,000.
Girgenti allegedly “did not properly supervise his staff in the purchase of medicine and supplies for the clinic,” according to the settlement. Seven doctors employed by Girgenti were also disciplined.
Girgenti said his employees were responsible for the narcotics troubles.
“I was on the tail end of this,” he said. “There were very specific protocols they were to follow for the ordering and storing of drugs. They didn’t follow protocol.”
Chiropractor Pleads Guilty in Patient-death Case
PENNSYLVANIA: Joanne M. Gallagher, DC, who practiced for close to 20 years in Hazleton, PA, was convicted of insurance fraud in connection with the death of a 30-year-old epileptic woman whom she treated with cranial therapy. Court documents indicated that the patient died of severe seizures after she followed Gallagher’s advice to stop taking her anticonvulsive medication. The fraud involved submitting insurance claims falsely describing “meningeal balancing” as spinal manipulation. After learning that her fatal advice had been tape-recorded, Gallagher pled guilty to one count of mail fraud under an agreement that she surrender her chiropractic license in 45 days and agree not to resume practice unless cleared to do so by a federal court judge. Sentencing is expected to take place in September. The crime carries a maximum sentence of 5 years in prison and a $250,000 fine.
www.Phillyburbs.com
Animal Rights Group Harassing Palmer Colleges
FLORIDA: Bea Arthur, the star of “Golden Girls” and “Maude,” has joined an animal rights organization in criticizing Palmer Chiropractic University System’s animal research.
The actress recently left taped telephone messages for dozens of employees at three Palmer campuses. She claimed that the Davenport, Iowa-based Palmer “mutilates” cats and asked its employees to oppose the school’s chiropractic research, according to the Associated Press. She made the calls on behalf of People for the Ethical Treatment of Animals.
PETA’s Web site urges supporters to contact Palmer officials. Employees at Palmer College of Chiropractic Florida said PETA’s campaign has led to dozens of “abusive” letters, e-mail messages and phone calls, the AP reports.
“It’s outrageous. (PETA) encourages people to call and harass us,” Palmer spokesman Randy Heuston said. “They have placed their philosophy of animal rights above medical, chiropractic health care progress.”
Chiro Wire
Are you sure that new patient isn’t part of a “sting” operation?
TEXAS: A Jasper, Texas, chiropractor is facing felony charges following an undercover “sting” operation conducted by Texas Mutual Insurance Company. On July 15, 2003, a Travis County grand jury indicted Dr. Michael T. Fleck, owner of East Texas Chiropractic, on insurance fraud-related charges.
Investigators affiliated with the Texas Mutual Insurance Co. began reviewing Dr. Fleck’s billing practices after learning that he had taken several patients off work after other doctors had already released them to return to work. In some cases, Dr. Fleck allegedly refused to return patients to work even when they said they were pain-free and able to return to work. The investigation also revealed that Dr. Fleck allegedly charged unusually large amounts for so-called “aquatic therapy.”
A workers’ compensation specialist assisted the investigators by posing as an injured worker. Dr. Fleck treated him for several weeks, and the investigators documented it, minute by minute. Later, the investigators contrasted the treatment Dr. Fleck delivered with the bills he submitted for the treatment. Their findings allege that Dr. Fleck fraudulently billed Texas Mutual Insurance Company for services not rendered and for services to which he was not entitled payment.
The Fleck investigation is part of Texas Mutual’s “Zero Tolerance for Fraud” program. Texas Mutual maintains three teams of fraud investigators permanently assigned to investigate every report of suspected fraud.
www.insurancejournal.com
Life and CCE Bury the Hatchet!?
GEORGIA: Life University, the nation’s largest chiropractic school, graduated about 300 students on Sunday, June 15, u u2003, a year after the Council on Chiropractic Education pulled the university’s accreditation, reports The Atlanta Journal and Constitution.
After the university learned it would take a minimum of two years to restore its credentials, the school sued the Council for more than $100 million in damages. A federal court restored Life’s accreditation in February until the lawsuit could be resolved, an order which the CCE appealed.
But, wait! Life and the CCE have buried the hatchet. An official news release issued jointly by the two entities states that Life’s current accredited status will remain in effect and provides for a special accreditation process that is scheduled to be completed by the University by the end of January 2005.
Chiro Wire
D’Youville College to Offer Chiropractic Program
New York: In what many consider a ground breaking move in healthcare education, D’Youville College has announced it will be offering a Doctor of Chiropractic program beginning in 2004.
D’Youville will be the first standard accredited multi-disciplinary college in New York State to “mainstream” chiropractic education by offering the Doctor of Chiropractic degree and only the second college in the country to do so. (The University of Bridgeport in Connecticut started their program in 1990.) Canada, a major source of students for D’Youville, has only one school of chiropractic.
The State Education Department approved the program in June and D’Youville is now actively recruiting freshmen students.
Previously, students interested in the chiropractic profession had to attend one of 16 single purpose institutions nationwide primarily dedicated to chiropractic education. Now, with D’Youville entering the field, a student will take liberal arts and science courses required for an undergraduate degree with students from other health-related disciplines and then embark on professional level evidence-based chiropractic studies.
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U.S. House of Representatives Demands Veterans Affairs Department Hire DC’s
VIRGINIA: The House of Representatives has formally ordered the Department of Veterans Affairs to speed up the implementation of chiropractic services into the veterans health care system—a requirement that was passed into law in 1999 but has since been delayed by bureaucratic foot dragging. The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) strongly supported the measure and have been working closely with a bipartisan coalition of key legislators to ensure its passage.
The bill, known as the “Veterans Health Care Improvement Act (HR 2357),” was passed by voice vote on Monday, July 21. Championed by Rep. Jerry Moran (R-KS) and Rep. Rob Simmons (R-CT), Chairman of the Veterans’ Affairs Subcommittee on Health, it contains a provision instructing the VA to hire and employ doctors of chiropractic. Legislation passed in 1999 (P.L. 106-117) required the VA to develop a plan for offering chiropractic care, but the new bill goes a step further and eliminates the remaining bureaucratic obstacles that have prevented the formal establishment of chiropractic clinical care in the VA.
Chiropractor Sentenced to Five Years in Prison for Fraud
FLORIDA: A chiropractor that once ran for City Council will spend more than five years in prison for his part in a million-dollar health care fraud scheme.
Russell Posner was sentenced in late June to 63 months in prison. He must pay $782,188 in restitution and undergo mental health and substance abuse evaluation and treatment.
He pleaded guilty in February to making false claims to Medicare, conspiring to defraud the Social Security Administration and racketeering.
“He basically plead to protect his family from having to go through a trial,” Posner’s attorney said. “He has young kids, and he wanted to minimize the harm to them.”
For years, Posner headed a storefront office on Pine Island Road, posing as a $6-an-hour clerk too arthritic to work as a chiropractor, prosecutors have said.
In reality, prosecutors said, he wrote prescriptions, passed out pills, and helped others mastermind ways to cheat public and private insurance companies with phony claims.
South Florida Sun-Sentinel. Distributed by Knight Ridder/Tribune Business News.
WV Chiropractors Lead Country in Worker’s Compensation Payments
WEST VIRGINIA: State lawmakers are working to maintain funding for the worker’s compensation system—and chiropractors should be rooting for them all the way.
Chiropractors who live in southern West Virginia make more from worker’s compensation payments than their colleagues in other parts of the country, according to the Charleston Gazette-Mail. And if the state legislature cuts back on the system, that could mean a sizeable pay decrease for chiropractors.
Overall, physicians of all specialties from the South made more from worker’s compensation payments than their counterparts elsewhere. Most of the 20 individual physicians who received payments between 1998 and 2002 that ranged from $857,598 to approximately $2.6 million came from southern counties.
Ten of the top dozen chiropractic centers for worker’s compensation reimbursements were located in or around the West Virginia counties of Nicholas, Mercer and Wayne. Four chiropractic clinics received more than $2 million during the past five years.
Chiro Wire TAC