Chiropractor

All posts tagged Chiropractor

New York DOJ Chiropractor Arrest

by admin on October 8, 2020 No comments

new york chiropractor arrestBy: Zach Simpson

Earlier this week a complaint was unsealed in federal court in the case of The United States of America v. Joseph Stephan that charged Stephan, who is a chiropractor, in New York with violations of 18 U.S.C. § 1347 (health care fraud) for submitting false claims to the U.S. Department of Labor (DOL) Office of Workers Compensation Program (OWCP) for services that were not actually rendered or were up-coded based on an undercover investigation.

Specifically, the complaint states that CPT code 99204 is a code used to identify an office or other outpatient visit for the evaluation and management of a new patient, which requires three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. The description of CPT code 99204 indicates that: (a) usually, the presenting problem(s) are of moderate to high severity; and (b) typically, 45 minutes are spent face-to-face with the patient and/or family.

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Groupon Fees and Marketing for Chiropractic Services

by admin on October 4, 2020 No comments

By: Zach Simpson

As the country reopens in light of COVID-19 many patients are beginning to feel safe to return to practices for services. In an effort to generate additional business to make up for lost revenue many practices have turned to internet-based marketing programs, such as Groupon to help attract new patients. Such sites provide a platform for discounted services, in exchange for a fee to refer patients to those businesses. While every state and business is different, chiropractors need to be aware of the implications of working with such sites while accepting federal health care insurance reimbursements, and the marketing requirements that still must be adhered to that often go overlooked.

When a discount is offered, Groupon customers (in this case, chiropractic patients) pay fees directly to Groupon. The chiropractor is then paid a percentage of the fees collected. Such marketing might affect Federal laws, for patients covered by federal insurance programs. The federal anti-kickback statute (AKS) prohibits any person from knowingly and willfully offering or paying cash to any person to induce the person to refer a patient for services for which payment may be made under a federal healthcare program. While some safe harbors exist, none specifically fit in a case like this.

Splitting the revenues with Groupon may pose a legal problem for chiropractors practicing in Florida as well, under the Florida Patient Brokering Act, which is enforced regardless of payor, and other fee-splitting prohibitions.

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$20M PLEA: DME Spider Web of Regulatory Enforcement Catches Another

by admin on September 28, 2020 No comments

By: Michael Silverman

2019’s crackdown on use of improper (tele)marketing and telemedicine in the durable medical equipment industry – aptly named “Operation Brace Yourself” – continues to unfold as we head into the last quarter of 2020.

The latest pertinent Department of Justice press release, criminal information and guilty plea informs that a chiropractor in Florida recently pled guilty to one count of conspiracy to commit health care fraud surrounding his involvement in companies improperly billing Medicare (and other federally funded health care programs) for durable medical equipment.

This individual admitted that he and his co-conspirators received more than $10,000,000 in payments after fraudulently billing more than $20,000,000 for durable medical equipment through several different companies.

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3 Simple Tips for Ensuring Proper Documentation in PI Cases

by admin on August 10, 2020 No comments

personal injuryBy: Zach Simpson

What follows is a very common scenario that helps demonstrate why proper documentation is essential in all personal injury cases, and what steps can be taken to ensure proper documentation occurs from the very beginning. Typically, following a car accident or slip and fall, a patient will present to the ER with complaints of “neck pain” only. However, the next day the patient might wake up with mid-back, and low back pain that radiates down the right leg, in addition to the original neck pain. The pain does not go away and gets worse, so they decide to make an appointment to come see their chiropractor.

The Problem Starts Here

When a new patient comes in for the first time, he or she typically starts the visit by completing a detailed history form. One of the first prompts is, “please tell us what hurts,” and there is a diagram that accompanies this question where the patient is asked to, “circle the areas that hurt.” More than likely the patient then puts or circles “neck, mid back, low back, and right leg.” The next question that typically follows the diagram asks, “When did your pain begin?” The patient then puts “4 days ago following my car wreck.” The potential problem for the treating chiropractor starts here. When the note is dictated it will more than likely read something to the effect of “New patient presents with history of neck, thoracic, and lumbar pain with radicular complaints, all of which began immediately after an MVA 4 days ago.”

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New Tens Unit Licensure Exemption Florida

by admin on August 10, 2020 No comments

tens unitBy: Michael Silverman

Did you know? With the passage and recent implementation of Florida’s Senate Bill 1742 there is a new exemption in place for the otherwise required Home Medical Equipment (“HME”) license for providing TENS units to patients.

More specifically, as of July 1, 2020 MDs, DOs and DCs are now exempt from that HME licensure requirement so long as such licensed healthcare practitioners are engaged in the sale or rent of such electro stimulation equipment to their patients in the course of their practice.

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Webinar | Chiropractic Compliance crash course

by admin on July 29, 2020 No comments

During this webinar attorney Zach Simpson will familiarize and refresh chiropractors on Florida’s statutes, laws, rules, and regulations which govern the chiropractic profession here in “The Sunshine State”. This course is for everyone. Whether you are just getting into practice or have been in practice for years, this crash course will provide a high level overview of Florida’s Rules and Regulations and show their practical application to every day practice.

During this presentation we will specifically focus on the following:

Chapter 456
Disqualification for license, certificate or registration
Required Content of Medical Records
Accounting of Patient Medical Records Retention
Florida Patient Self-Referral Act
Florida Anti-Kickback Act
Florida Brokering Act
Florida Requirements Section 1557 of the Patient Protection and Affordable Care Act
The Compliance Manual

Chapter 460 I will discuss the following
Itemized patient billing
Violations and penalties
Sexual misconduct in the practice of chiropractic medicine
Grounds for disciplinary action
Chiropractic physicians subject to state and municipal rules and regulations
Proprietorship by persons other than licensed chiropractic physicians

Most Frequently Violated Laws and Rules
Solicitation
Advertising
Inadequate Records
Financial Exploitation of Patients
Professional Boundaries
KickbacksWebinar register here button

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Personal Injury Protection (PIP) Payments for “Physical Therapy Modalities & Services” Are Not Reimbursable When Rendered by a Massage Therapist in Florida

by admin on July 19, 2020 No comments

massage therapy and pipBy: Zach Simpson

You may not be aware that the Third DCA ruled earlier this year that “Physical Therapy Modalities & Services” such as electrical muscle stimulation, ultrasound, heat, ice, and traction are not reimbursable under PIP when rendered by a massage therapist in any practice setting. Pointing in part to a law that took effect January 1, 2013 an appeals court sided with Geico General Insurance Co. in a dispute about paying for physical-therapy services provided by massage therapists to auto-accident victims.

Case Details

The Miami-Dade County case involved bills for three patients sent by Beacon Healthcare Center, Inc., under the state’s personal injury protection, or PIP, insurance system.

Physical therapy and physical therapy modalities (i.e. electrical muscle stimulation, ultrasound, heat, ice, and traction) were prescribed for auto accident patients by Beacon’s treating physician and medical director which were performed by massage therapists rather than physical therapists. Neither a licensed physician nor a physical therapist directly supervised the care performed by the massage therapists. However, when Beacon billed GEICO they noted that the supervising physician, and not the massage therapists, provided treatment.  The billing statements also indicated that the massage therapists performed physical therapy modalities under the direct supervision of the medical director, whose only responsibility was to review patient files monthly. Geico General Insurance Company denied payment, which led to Beacon filing a suit in Circuit Court.

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Webinar | Adding DME to Your Chiropractic Practice

by admin on April 16, 2020 No comments

adding DME to your chiropractic practice Attorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.

During this “lunch n’ learn” Mike & Matt will break down the steps necessary for a chiropractic office to provide DME to its customers, be it cash paying, commercially insured, or Medicare patients alike.

In case you missed it:

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Webinar | Adding DME to Your Chiropractic Practice

by admin on April 7, 2020 No comments

adding DME to your chiropractic practiceAttorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.

During this “lunch n’ learn” Mike & Matt will break down the steps necessary for a chiropractic office to provide DME to its customers, be it cash paying, commercially insured, or Medicare patients alike.

April 16 @ 12:00 pm – 1:00 pm

Free

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Direct Primary Care Agreements: How it Works and What to Consider

by admin on October 24, 2018 No comments

direct primary care agreementsAttorneys Susan St. John and Michael Silverman of the Florida Healthcare Law Firm will present this live lunch n’ learn webinar for providers interested in learning more about the direct patient care model. They will discuss the recent legislative updates that have brought this issue to the forefront in Florida.

Further reading per AAFP.org – The direct primary care (DPC) model gives providers a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies. Direct primary care and concierge care are not synonymous. In practices offering concierge care, the patient typically pays a high retainer fee in addition to insurance premiums and other plan obligations (e.g., copays, out-of-pocket expenditures), and the practice continues to bill the patient’s insurance carrier.

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