PHOENIX, Arizona -- Lawyers representing 26 state chiropractic associations, the two national associations, and two chiropractic colleges convened November 3-5, 1995 in the Arizona capital for the annual meeting of the National Association of Chiropractic Attorneys (NACA).
Research
The NACA members took a strong stand in support of chiropractic research, voting to support continuing research by making contributions to the Foundation for Chiropractic Education and Research (FCER), the Foundation for Advancement of Chiropractic Tenets and Sciences, and the Consortium for Chiropractic Research.
Paul Lambert, NACA president and attorney for the Florida Chiropractic Assoc., reminded the attendees that the Lincoln College Education and Research Fund is raising $1 million, to be matched by the Florida legislature, to establish an endowed research chair at Florida State University in chiropractic and biomechanical research.1 "This is a first to have a chiropractic research chair at a state university," said Dr. Reeve Askew, ACA liaison to the NACA. The NACA voted to donate $1,000 to the endowed research chair fund. Dr. Askew urged chiropractors to donate to the Lincoln Foundation's efforts and meet the June 1996 deadline for raising the $1 million.
Anti-Trust
Attorney Joel Kruh (Maryland Chiropractic Assoc.) reported on the growing complexity of anti-trust laws faced by associations. He presenting a simplified update on anti-trust laws for each lawyer to take home to help associations avoid anti-trust pitfalls.
State Farm
NACA members continue to report problems chiropractors are having throughout the U.S. with State Farm cutting off treatments of automobile accident patients, delays in payments, and refusal to pay medically necessary treatments. "It is unfortunate that so many of us are being forced to unnecessarily sue State Farm in avoidable controversies," said David Morrison, general counsel of the Arizona Association of Chiropractic.
"A trend is developing in which chiropractors are starting to represent themselves in small claims suits against State Farm for unpaid claims of small amounts and they are winning," said Shawn Steel, counsel for the Cleveland Chiropractic College, L.A.
"State Farm will be inundated as chiropractors learn to represent themselves in small claims courts," predicts Judy Pope, General Counsel for the Kansas Chiropractic Association.
Reviewers Changing CPT Codes
"Changing CPT codes by claims reviewers is becoming an increasing problem," pointed out attorney Arly Richau (North Dakota Chiropractic Assoc.). The group agreed that changing a doctor's CPT code on a claim form to another CPT code for the purpose of reducing a claim is a fraudulent act.
"NACA lawyers should bring this to the attention of every insurance commissioner and seek a ruling to stop this practice which amounts to fraudulently changing a diagnosis or delivered treatment," urged Mike Schroeder, who represents the California Chiropractic Association and Hawaii Chiropractic Association. "The California Department of Insurance and Division of Workers' Compensation issued opinions finding that changing CPT codes is an unfair claims practice," Mr. Schroeder added. Those opinions are being sent to each NACA member for use in obtaining a local state opinion.
Medicare
Brian Neiderhauser, counsel for the ICA, reported on the efforts of the ICA in negotiation with the Office of Managed Care regarding HMOs which purport to offer manipulation by physical therapists and others in lieu of chiropractic services under Medicare. "We understand that our position has prevailed in California and are urging the Department of Health and Human Services to adopt the policy nationwide," said Mr. Neiderhauser.
Tom Daly, general counsel to the ACA, and Dr. Reeve Askew, ACA/NACA liaison, reported that Medicare is now recognizing chiropractors as physicians which will return dividends in the future. Dr. Askew and Mr. Daly presented an explanation of the use of the A2000 codes and the new RBRVS rules for reimbursement for the lawyers to take back to their associations to explain.
Multidisciplinary Practices
"Multidisciplinary practices may be the future for health care delivery," reported Rob Sherman, general counsel to the Ohio State Chiropractic Association. Mike Schroeder, joined by health law expert Donn Kessler, who practices in Phoenix, presented a seminar to NACA members on the latest developments in establishing multidisciplinary practices that include chiropractors, allopaths, osteopaths, podiatrist, physical therapists or massage therapists.
Workers' Comp.
"Chiropractic is a minimal cost in the workers' compensation system, according to a report by the National Institute of Workers' Compensation presented to the National Governors Conference," attorney Aubrey Villines (Georgia Chiropractic Assoc.) reported. Mr. Villines supplied every member with a copy of the report that shows the effectiveness and low cost of chiropractic in the workers' compensation system.`
Letters of Protection/Doctor Liens
The NACA spent considerable time discussing letters of protection and doctor liens. "Letters of protection and physician liens are not being respected," observed attorney John Vos (Michigan Chiropractic Council).
Attorney David Spencer (Michigan State Chiropractor's Assoc.) said that chiropractic attorneys need to urge their state bar associations to issue rulings on enforceability of doctor liens.
Managed Care
"More states are setting up PPOs for the chiropractors to more effectively compete in the managed care health care market," said attorney John DeCamp (Nebraska Chiropractic Physicians Assoc.). A poll of NACA members shows that at least seven states are establishing chiropractic statewide PPOs.
Chiropractic inclusion in HMOs remains a focus of the NACA. "The key to get more chiropractic participation in HMOs is to develop patient demand for chiropractic care," said attorney Mike Kelly (South Carolina Chiropractic Assoc.). "I'm spending about 20 percent of my time working to get HMO subscribers in South Carolina to urge their HMOs to sign up more chiropractors," Mr. Kelly added.
Cash Discounts
"More chiropractors are asking about cash discounts," said attorney Bill Shields (Virginia Chiropractic Assoc.), "but are concerned with state laws prohibiting cash discounts."
"One way to protect our clients is to ask each NACA member to seek opinions from the insurance commissioners about what is permitted in each state relating to cash discounts," urged attorney Lorri Silveria (Chiropractic Society of Rhode Island).
Insurance Audits
Insurance audits of chiropractors are increasing. Attorney Bob Hirtle (Connecticut Chiropractic Assoc.) reported that DCs across the country are being "audited for overbilling by insurance companies under their provider agreements." Insurance companies are demanding refunds for treatments found to be unsubstantiated by audits. Insurance companies are also filing criminal fraud complaints against chiropractors whose records are found not to substantiate claims submitted to insurance companies under provider agreements entered into between chiropractors and the insurance companies. "We need to prepare our association members for audits and how to avoid unintentional billing errors that can later look fraudulent," warned Mr. Hirtle.
The NACA will conduct an insurance fraud seminar at its mid-year meeting in June to teach the lawyers about insurance company audits and what is considered fraudulent. The seminar will be taught by insurance fraud investigators, Medicare representatives and others involved in the field. "NACA members will take the information to their associations to the benefit of all chiropractors, which is what makes NACA membership so valuable," said attorney Jim Hogan (New York Chiropractic Council).
Judicial Victories
General counsel Jim Kutz (Pennsylvania Chiropractic Society) reported on a 1995 opinion by the Pennsylvania Supreme Court interpreting the Pennsylvania Workers' Compensation Act to require a workers' compensation insurance company to reimburse an injured worker for chiropractic treatment, where the treatment was necessary and reasonable for the type of injury involved and where no suitable physician or practitioner (in this case a chiropractor) was included on the list of designated physicians or practitioners of the healing arts. "This is a significant precedent setting opinion for which Jim Kutz is to be greatly congratulated. He took a losing case and turned it into a great victory," observed Jake Ladenheim, NACA associate member.
"NACA lawyers are responsible for more and more precedent setting court decisions which are benefitting chiropractors all over the country," said attorney Steve Elliott (Miami Valley (Ohio) Chiropractic Assoc.).
Sexual Misconduct
NACA lawyers are focusing on ways to help chiropractors avoid malpractice. Liz Kinkaid, NCMIC general counsel, reported that sexual misconduct allegations are increasingly being filed against chiropractors. "A casual unintended comment or action can be perceived as a sexual advance encouraging an otherwise disgruntled patient to file a malpractice suit," she contended.
"We need to make chiropractors more sensitive to situations which can get them into trouble," observed attorney Lorri Silveria (Chiropractic Society of Rhode Island).
"Chiropractic necessarily requires close body contact and every male chiropractor should protect himself by having a female assistant in the room while adjusting a female patient," warned attorney Paul Lambert (Florida Chiropractic Assoc.).
"Attorney of the Year"
The NACA recognized Mike Schroeder as the "Steven M. Dickson Chiropractic Attorney of the Year" for his hard work and outstanding contributions to the chiropractic profession. The award is given in memory of Steven Dickson who died in route to Washington D.C. to advocate for chiropractic in the national health care plan. Steven is remembered as setting a high level pace of accomplishment that many of the attending attorneys admire and seek to emulate.
Mid-Year Meeting
The NACA will hold its mid-year meeting June 28-29, 1996 in Manhattan, New York. The agenda will include seminars on Medicare fraud, insurance provider audits, malpractice issues and more. Each state association and college is urged to have its legal representative participate in the NACA mid-year and annual meetings. "We learn more and more from each other as more lawyers attend and participate in these meetings," said Paul Lambert, NACA president. "The associations are the winners as a result."
For more information on NACA, contact Paul Watson Lambert, president, at (904) 385-9393
Reference
1. Chiropractic/biomechanical research center at Florida State University is planned. Dynam Chiro, 9-1-95.
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