ACA Joins Class Action Against UnitedHealth
The class-action lawsuit against UnitedHealth Group filed on Jan. 24, 2011, by Pomerantz Haudek Grossman & Gross LLP, on behalf of a group of chiropractors and the Ohio State Chiropractic Association, and subsequently joined by the Congress of Chiropractic State Associations, has another plaintiff: the American Chiropractic Association. The ACA Board of Governors voted to join the suit in late April.
"United's attempts to intimidate and coerce patients and providers can no longer be tolerated. They must be challenged with a unified effort by the chiropractic profession," said ACA President Rick McMichael, DC. "Patients' right to receive medically necessary care must be protected and insurers must be held accountable to pay for care patients have paid for through their insurance premiums."
On April 22, the ACA amended the original complaint, alleging that postpayment audits and recoupment tactics were "only part of the scheme undertaken by United to enhance profits through denial of benefits otherwise due and payable under the insurer's plans." The amended complaint alleges that UnitedHealth, through its chiropractic network OptumHealth, "adopted a series of policies and procedures intended to improperly deny benefits." Specific additional allegations include the following, as detailed in an official ACA release:
Appeal rights have not been consistently afforded to patients when the care authorized differs from the doctor's care plan, in violation of ERISA.
Optum, in a deliberate effort to avoid its obligations under ERISA, refuses to allow providers to request a particular number of visits or procedures, or to submit clinical information necessary for utilization review.
Providers are subjected to threatening communications in an effort to pressure them to reduce utilization rates.
Optum relies on statistically invalid data to determine average utilization rates. It further manipulates data and pressures providers to reduce care, thereby reducing what is reported as the "community standard" for proper levels of care.
Even though doctors only provide the services pre-authorized by Optum, the network continues to declare that the averages derived from those authorizations are inappropriate and pressures providers to reduce care.
ACA's amended complaint requests the federal court to enjoin United from continuing to apply the Optum policies that are used to improperly reduce coverage for chiropractic services, and order United to disgorge the profits it has earned by denying such coverage, through its actions taken in violation of ERISA, plus interest.
N.J. DC Named Sports Chiropractor of the Year
Dr. Blasé Toto of East Brunswick, N.J., a member of the Association of New Jersey Chiropractors, is the "Sports Chiropractor of the Year" as designated by the American Chiropractic Board of Sports Physicians. Dr. Toto received the award at the 2011 Chiropractic Sports Sciences Symposium in Boston.
The American Chiropractic Board of Sports Physicians is the national certifying body for chiropractic sports physicians. The recipient of the Sports Chiropractor of the Year award is chosen by former award recipients.
"This is the gold medal and highest honor in my profession," said Dr. Toto. "I am honored to receive this prestigious award and recognition. It is especially meaningful because it is voted on by my peers."
Dr. Toto, who served on the U.S. Olympic Medical Team during the 2010 Winter Olympics in Vancouver, British Columbia, has been in practice for more than 25 years. During that time, he has treated a wide range of athletes from Pop Warner football players to Olympians.
"We are extremely proud to learn of Dr. Toto's honor as the Sports Chiropractor of the Year," said Dr. Steven Clarke, president of the ANJC. "His accomplishments have gained our industry great recognition for the benefits chiropractic care has on athletic performance for all age groups and levels of competition."
The Vitality Depot Donating Portion of Proceeds to TCA
With the medical profession in Texas still intent on stripping (or at least severely limiting) chiropractors' right to diagnose, the Texas Chiropractic Association (TCA) is looking for support wherever it can get it. Enter The Vitality Depot, which recently announced it is donating $500 for each dual-probe and $250 for each single-probe Vitality Clinical Irradia MID-Laser unit sold to Texas chiropractors from April 1 – Sept. 20, 2011.
"We believe that health care should be progressive with open access to care, not regressive and restrictive of patient choice and discriminatory against any profession," said Dr. Mark Mandell, president of The Vitality Depot. "When an injustice like this occurs, current and future patients may be denied access to necessary care, and that is unacceptable. The Vitality Depot supports open access and advancements in patient care, so we feel it's important to support the TCA in their efforts."
To support the Texas Chiropractic Association's legislative and legal efforts to protect chiropractic diagnosis, visit www.chirotexas.org and make a one-time or monthly donation. Interested doctors and patients can also stay updated by signing up at www.mytexasdoctor.org and learn how to contact their state representatives regarding this important issue. For background information on the Texas Medical Association's efforts to "contain and eliminate" chiropractic in Texas, read "Texas Judge Rules on Diagnosis Issue: Is Some Diagnosis Better Than None?" in the Oct. 21, 2010 issue.
Celebrating National Public Health Week, Chiropractic Style
From April 4-10, students, faculty and staff at Cleveland Chiropractic College – Kansas City (CCCKC) celebrated National Public Health Week by participating in activities in support of the week's theme, "Safety Is No Accident: Live Injury-Free."
"National Public Health Week promotes the health and well-being of our students, employees and community," said Dr. Karen Doyle, director of the Master of Science in Health Promotion (MSHP) program at CCCKC. "The health of our community ultimately affects the health of our nation and our economy. In addition to investing in our community, Cleveland chose to expand this opportunity to include global awareness as well."
College activities during the week included an on-campus shoe drive, with well-worn athletic footwear collected for the "Nike Grind" recycling program. The program grinds used athletic shoes and then repurposes them for playgrounds and other sports venues. In addition, the CCCKC shoe drive collected lightly worn shoes to be distributed to those in need.
Literature about safety solutions also was offered at several locations around the campus, promoting health and safety while supporting the MSHP program. Special attention was given to safety issues when running and biking Jessica Tallman, a student at CCCKC, took part in National Public Health Week activities at the college and said it was a great way to maintain the focus on health that is such a core part of the chiropractic curriculum:
"As chiropractors and chiropractic students, it is our duty to be involved in public health," she said. "To reach health is our goal, and it should be encouraged both inside and outside of our offices, schools, and homes. Public Health Week gives us the opportunity to draw attention to those things which help us better reach that optimal level of health."
Georgia DC Adds to His Résumé: Supporting Role in Upcoming Motion Picture
Dr. Daniel Batchelor, a longtime Roswell, Ga., doctor of chiropractic (and equally longtime contributor to this publication), is taking on a whole new role as a supporting actor in the motion picture "Against the Wind," scheduled for release this fall. The action-adventure, filmed in Malaysia, the jungles of Nicaragua and Costa Rica, and the mountains of North Carolina, features Dr. Bachelor "as a World War I fighter pilot who later becomes an undercover DEA agent who is sent to eliminate several drug lords involved in an opium business that exports opium throughout the world."
When not practicing chiropractic or memorizing scrips, Dr. Batchelor is also an experienced triathlete and has been a consultant for publications such as Runner's World. And by the way, he also participated as a dancer during the opening ceremonies of the 1996 Summer Olympics in Atlanta.
