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Who Commits More Insurance Fraud?

Dear Editor:

How are topics/questions for your ChiroPoll feature selected? Could you phrase a poll question to the effect of, "Whom do you believe commits the most insurance fraud?" Choices: chiropractors; other providers; patients; or the insurance industry, including insurance companies and managed care organizations.

I ask because of my multi-year concern that chiropractic organizations generally have not proactively confronted the insurance industry about the abuses committed by the insurance industry against doctors, hospitals and patients. I understand the politics and niceties of appeasement, rapprochement and trying to work cooperatively with the insurers and their MCOs, but in another sense I see chiropractors and patients victimized by insurers all the time, and our attempts to work together with the carriers is like trying to form a partnership with the burglars at our front door to minimize their looting at the back door. "We're all on the same team working for the same goal" is simply a fallacy.

What brought this to the forefront in my mind? Two very recent events: On June 23, our fine California Chiropractic Association announced that it was filing yet another massive lawsuit against Wellpoint/Anthem/Blue Cross because of reimbursement abuses committed against California DCs. A day later, a colleague showed me another insurer's latest scam. One of the carriers sends the DC an e-mail after a claim is received and offers to provide "expedited payment within 2 weeks" if the DC will accept a 30 percent cut - and the implication is that if not, the DC will have their claims put on the bottom of a large pile and not paid for several weeks, and be labeled as "uncooperative."

How is this not extortion? Why shouldn't a DC who submits an honest bill on a clean claim form be paid in full in a short time period (time periods specified by state law and/or insurance regulations)? In sharp contrast, I note that insurance premiums must be paid on time and that carriers would not let an insured patient demand a 30 percent discount on premiums. How does this differ from Mafia hoodlums in the 1930s moving into small businesses and extorting a percentage of earnings for "protection" money? These two examples are outrageous to me and are further example of a multi-year pattern of insurance fraud committed by insurers against providers and patients.

I deplore insurance fraud in any form including overutilization by any provider, especially by a DC. That said, I contend that the insurance industry has the power to commit fraud on a massive scale that even the most crooked doctor could never achieve. The insurance industry has billions of dollars in its budget, the most sophisticated computers in the world, a workforce of tens of thousands of people at its command, lobbyists at all levels of government, high-powered expensive attorneys on retainer, investigation units, and control of the media. So, who has the power to commit the most fraud? A DC in solo practice with one assistant in a small office? Or the mega-industry with all its resources, wealth and power? I think the answer is pretty obvious.

How many class-action and other lawsuits against insurance companies have resulted in multi-million dollar settlements to providers in the past decade? And that is clearly only the tip of the iceberg. Has any reporter or researcher actually written an article or constructed and published a table showing the names of the carriers, dates, sizes of settlements/judgments in favor of providers and patients? It would be an eye-opener for the public and for legislators. I've read of several judgments and class-action settlements just in my own casual reading. Someone needs to put them all in one document and then circulate it widely.

As a side issue, but related, how do the salary and other compensation packages of insurance industry executives compare with the annual average earnings of a DC in private practice who takes care of the sick, injured and wellness-seekers?

Finally, how many DCs in the U.S. have lost their licenses to practice and been put out of business permanently after an insurance fraud conviction? Answer: several hundred at least. How many insurance companies have lost their state permit or charter to write insurance and been put out of business after being found guilty or settled a lawsuit for millions? Zero. They just pay up out of their huge reserves and continue business as usual.

Above is my rant of the day. Now back to my original question about ChiroPoll and my suggestion: I think the results would be interesting (but not surprising), even more so if you included a way to submit comments and examples. But be forewarned: I made similar comments in an article in our local newspaper many years ago and for several days afterward, the favorable responses actually overwhelmed the capability of my office phone system to respond.

Rand Baird, DC, MPH, FICC
Torrance, Calif.

Note: The above is the opinion of the author and does not and should not be construed as positions of the World Federation of Chiropractic. (Dr. Baird chairs the WFC's Public Health Committee.)

Are We Going to Erode Into Obscurity?

Dear Editor:

I have been in practice for approximately 25 years. In that time, I have seen more of us (doctors of chiropractic) not wanting to expand our profession and services than any other profession. My brother is a dentist, I also went to medical school, and I know PTs, nurses and psychologists as well. All have continued to expand their power by practice expansion.

Now I find that after 25 years of doing federal DOT/CDL exams and school bus driver exams for two counties, the school system has decided that only MDs/DOs can do what they now call a "DOE physical" for school bus drivers. This means all DCs are cut out of the opportunity to do a lesser examination than they are allowed to do with the federal government! This dramatically reduces the exposure these people and their families will have to the chiropractic profession. [To learn about federal guidelines that allow chiropractors and other providers to perform DOT exams, read "NRCME Implementation Delayed" in the June 17 issue.]

How can we not be angry and want to fight for equal rights? Oh, I forgot, we do not want to deal with bloodwork or drugs in any fashion. I guess then some might say since we do not do that, we shouldn't do urinalysis, either. Just because a small portion of our profession does not want to provide these and other services should not prevent others from doing it. This is the attitude of all other health care professions, including massage therapists.

Why are we choking ourselves off? Do we really want PhDs in physical therapy to take over our position? After all, if you are an insurance carrier and have a choice of a limited group or a group that expands its abilities, whom are you going to cover? One group will die away eventually - can you guess which one? Are we going to allow our profession to erode away slowly into obscurity, or are we going to expand? We are half of what we were in the '80s. I know.

Ronald C. Clark, DC
City/State Unknown

Dynamic Chiropractic encourages letters to the editor to discuss any issue relevant to the profession, including response to articles that appeared in a previous issue of the publication. All letters should be e-mailed to editorial@mpamedia.com with "Letter to the Editor" in the subject field. Submission represents acknowledgement that your letter may appear in a future issue of DC, but does not guarantee publication. We receive considerable correspondence and endeavor to publish as many perspectives as possible.