M&Q Fraud Charges Levied against 172 People in NJ NEW JERSEY: Alter a 19-month investigation, prosecutors recently announced the indictment of 172 people in New Jersey, includ- intz a medical doctor, a lawver and two chiropractors. charging them with staging 19 automobile accidents and filing false medical claims totaling more than $5 million. Prosecutors say the defendants operated an elaborate network that staged the collisions between March 1997 and December 1999 in several New Jersey counties. "Runners" would allegedly recruit drivers and passengers, who would meet ahead of time to discuss details of the staged collisions, which were mostly minor. Participants were supposedly paid up to $2.500 and would be coached about the types of injuries to fake. The medical professionals would then file claims with the drivers" insurance companies for services never rendered. A similar insurance fraud in New Jersey two years ago resulted in a law making it illegal to act as or to employ a runner, regardless of the legitimacy of the claim involved. New York Times Aetna to Reduce Chiropractic Coverage CONNECTICUT: Ailing health insurance company Aetna plans to limit the number of chiropractic treatments it covers, according to The New York Times. The cut will make up for losses associated with other soaring health care costs, such as prescription drugs and outpatient surgery. Aetna posted a first-quarter loss of $48.2 million. Eli Research Chiropractor Convicted of Insurance Fraud VIRGINIA: A Chesapeake chiropractor was convicted recently in federal court on charges of defrauding the federal government for three years by submitting phony patient bills. The 39-year-old chiropractor was convicted of bilking the government of $90,000. A jury found him guilty of 24 counts and his business also was found guilty. The jury found that the chiropractor submitted false bills to TRI-CARE/CHAMPUS. the military's managed health-care program, and the Federal Employees Health Benefits Program, administered by Trigon Blue Cross Blue Shield, from 1997 to 2000. The defendants allegedly submitted 23 false claims for three patients, each time claiming the patients had received covered treatment by medical doctors or doctors of osteopathy. Instead, the patients actually received non-covered treatment by the chiropractor. "The case is not about the quality of care received," Assistant U.S. Attorney Alan M. Salsbury told the jury during opening arguments. "It's not about whether a medical doctor and a chiropractor can provide care under the same roof. But they must bill separately." he said. The defense attorney argued that his client simply tried to comply with a maze of federal bureaucracy. "He did not intend to file any false statements." the defense attorney told the jury. "There was no intent to defraud. It was an intent to comply." The attorneys had no comment altci the verdict was read. The chiropractor is scheduled for sentencing on Oct. 19. He remains free on bond. Pilotonline.com CCA Suing ASHP CALIFORNIA: In a lawsuit filed at the end of June, in San Diego Superior Court, the California Chiropractic Association (CCA) claims American Specialty Health Plan (ASHP) practices are damaging the entire chiropractic profession. Specifically. ASHP's practices have negatively affected the patients' ability to access care and doctors" ability to provide that care. The situation is particularly difficult because ASHP is the first chiropractic managed care plan in California and is touted as being the first managed care plan to give Californians access to chiropractic care in significant numbers. "When ASHP started up it hurt those of us not contracted with them. I. personally, lost significant numbers of patients from my practice but. as a profession, we hoped ASHP would be a benefit to patients and doctors." says Robert Dubin, DC, CCA President. "Many of their current practices aren't beneficial to doctor or patient, and they have been substantially unresponsive to CCA's and doctors' biggest concerns. CCA has filed this lawsuit to ensure that doctors of chiropractic and their patients are treated fairly by ASHP." ASHP limits the number of doctors of chiropractic able to participate in managed care through their contracts. Those doctors who can't secure a contract with ASHP lose access to a substantial population of patients and lose existing patients to doctors who have contracts. CCA has asked California's Attorney General's office to assess whether this situation constitutes an illegal monopoly. www.calchiroassn.ore ICA Congressional Initiatives Focus on New Access to Chiropractic Services WASHINGTON. DC: Legislation has just been introduced in the U.S. House of Representatives, at the request of the International Chiropractors Association, aimed at opening up new access to chiropractic services for upwards of 20 million Americans through the Medicare and Federal Employees Health Benefits programs. These two initiatives represent responsible, practical and affordable policy enhancements that, when enacted, will make a major difference in the chiropractic economy in the United States and in the quality of health care and quality of life for millions of our citizens. MEDICARE: H.R. 2284. introduced by Representative John Lewis (D-GA). will expand the list of services reimbursed under Medicare to include examinations and X-ray services. This landmark bill will also provide that only doctors of chiropractic are authorized to deliver chiropractic services under Medicare. ICA urges all doctors of chiropractic, students, patients and friends of the profession to ask their Member of Congress to contact the office of Representative John Lewis at 202-225-3801 and ask to be added to the co-sponsors list for HR 2284. www, chiropractic, ore Poxx on the information to warn other DCs about events that are really happening to chiropractors. When you see a "yellow pane" article in your local, regional, or national newspapers about chiropractic or your fellow chiropractors, fax or mail it to us at TAC for further investigation. Fa.x to: I-305-716-9212 or see page 6 for our mailing address.
