npany Attacks nary Practices I An In-depth Interview w Practice Management Consul with Expert Witness & ultant, Dr. Daniel H. Dahan Who is Daniel H. Dalian, D.C.? After graduating from Life College in 1988, Dr. Daniel H. Dalian developed | and operated one of Southern California's largest inultidiscipline centers, with a staff ultimately consisting of a chiropractor, an orthopedist, a neurologist, an internist, a family practitioner, two physical therapists and jive massage therapists. Although Dr. Dalian's primary interest had been in homeopathy and holistic care, he eventually developed a set of very detailed protocols for a fully diversified chiro-medical rehabilitation center. Then, in the spring of 1994, he founded Practice Perfect and launched a series of seminars nationwide, teaching other doctors how to integrate their own practices. The seminars became so popular that, within a few months, doctors began asking him to consult for their clinics and help them manage their development in the inultidiscipline arena. To date, traveling at least a million miles per year, with an extremely busy schedule, he has set up over 800 centers in 45 states and personally instructed over 4700 doctors. In addition, he has written 21 very detailed patient education pamphlets specifically for the inultidiscipline center, as well as developed patient newsletters, marketing kits and so on. And, if that's not enough. Dr. Dalian is the happily married, proud father of 7 children! In an interview with The American Chiropractor (TAC), Dr. Daniel H. Dahan (DHD) answers TACs questions concerning the recent allegations being circulated in newspapers and over the newswires concerning Practice Perfect's involvement in a prominent New Jersey lawsuit focusing on a specific MD/DC clinic, Northfield Medical Center. TAC: Currently, rumors and reports abound concerning investigations of MD/DC practices, in several states. What can you tell us about this? DHD: The ever-growing limitations of chiropractic reimbursement, as well as the declining revenues to health professionals, have forced many doctors to seek desperate methods of survival. At the same time, unscrupulous consultants have "sprung up", confusing information has been spread, and false "sham protocols" have been set up. The MD/DC practice, with its medical license, became the quickest way to defraud the insurance companies, circumvent limits on chiropractic care, and collect higher fees. And, even though the information of the multidisciplinary center is perfectly "legal", its billing setup is extremely important; and, regardless of its location, it must abide by State and Federal rules and regulations. There are over 89 very serious investigations to date, that are known of or spoken about in the field. Of those, I have been asked to represent over 34 of them as an expert witness, both on the prosecuting as well as the defending side. (None of which are my clients, thank God). TAC: Why would you say this development is occurring? DHD: Over the last couple of years, insurance carriers such as Allstate, based on questionable legal authority at this point, have assumed the role of government regulator and gone beyond evaluation in conventional factors, such as whether prescribed testing and treatments are medically necessary and reasonable. They have embarked on a crusade to determine whether medical corporations structured as multidisciplinary clinics meet the respective state requirements for corporate structure. In some instances, these forays have been soundly rejected, as in the case of one Fresno court, which adjudged such an encroachment to be an abuse of process. Yet, in New Jersey, Allstate has garnered success, with one state court judge handing down a series of decisions which. when read collectively, infer that multidisciplinary practices are per se illegal. Of course, in these New Jersey cases, Allstate has been careful to bring suit against only the worst offenders, that is to say against multidisciplinary practices owned by plenary licensed physicians with ownership interests in more than two dozen clinics. Allstate has used these extreme examples to characterize multidisciplinary practices, in general, as "sham operations" and their physician-owners as "absentee owners". Unfortunately, bad factual circumstances often make bad law. Although, I am not an attorney, I can tell you that some of these arguments are absolutely ridiculous. For more information you can visit my website at www.dahan.com to read about some of these cases. TAC: What do you know about the criminal indictment that was just handed down in New York? DHD: Basically, the U.S. Attorney's Office brought a federal criminal indictment in New York against a medical doctor owning a multidisciplinary practice, and a chiropractor-employee, who purportedly exerted true control over the clinic. Should this case be tried to verdict, it will have far greater implications for the future of multidisciplinary clinics than the cases financed by insurance companies. There is no question in my mind that multidiscipline centers nationwide are seeing the laws being defined at the time of this article. TAC: What actions do you believe trigger an investigation? DHD: I can tell you that these are some of the most repeated offenses which have triggered investigations, (State and Federal) in the last several years: Improper legal structure Faulty internal accounting Excessive ordering of anscillary services Services deemed not medically necessary "Outrageous" billing fees Multiple payment plans Copays/Deductibles illegalities Improper coding Overextended treatment Proliferation of unusual testing PoorS.O.A.P. notes Huge profits over a short period of time Unlawful relationships with diagnostic companies "Marketed" services paid as splitting fees TAC: Recently, there was a news report circulating on the internet concerning an Allstate suit against Northfield Medical Center in New Jersey, which stated that a New Jersey judge had ruled that "...Practice Perfect and its affiliate...are at the center of a nationwide fraud scheme...." What can you tell us about this Allstate New Jersey case? DHD: Insurance companies have, for many years, managed successfully to delay and/or refuse to pay legitimate doctors' claims nationwide. It is of no surprise that, when a wave of multidiscipline centers were developed across the country, and many of them became very lucrative due to the increase of services rendered, American insurance companies became very worried. By properly supporting medical necessity, increasing credibility, using objective findings, and educating their patients, these "one stop shops" have ethically managed to increase their collections, as well. To "prove" that these centers were created with the attempt to defraud insurance companies, Allstate conveniently pursued a clinic which had allegedly disgorged SI4.1 million. (Allstate Ins. Co vs. Schick) Allstate is trying very hard to claim that these so called "multidiscipline centers" are "sham operations". One can only imagine why the same insurance companies who make it so difficult for any doctor to collect a legitimate claim, want to come after Practice Perfect. Indeed, even though this doctor Schick has never attended a Practice Perfect seminar, nor was he ever a client, the mere fact that one of his affiliated corporations, in this case, was set up by an attorney who spoke at some of my seminars, made Practice Perfect the "Alleged Leader" in the "sham operations". This is absurd. Each client hires an attorney to set up whatever structure is most appropriate and legal for that particular state. To think that Practice Perfect can openly convince hundreds , of doctors nationwide to defraud the ; insurance companies is absolutely ludi- I crous. ridiculous, and impossible. This i decision concerning owning multidis- i cipline centers invariably will have to reach the Supreme Court, since thou- sands of doctors of all disciplines currently operate under such a set up— which benefits millions of patients. The very fact that these clinics are lucrative is not due to fraud, but merely excellent and expert consulting, and management advice. This whole thing, obviously, is ridiculous in my opinion. Allstate's New Jersey litigation has also taken aim at requirements for diagnostic testing facilities. Once again, the insurance company's focus has been on licensure issues rather than the accuracy and reasonableness of the testing. In my attorney's opinion, it is a major setback for telemedicine and modern medicine in general. The New Jersey State court judge ruled that all diagnostic testing facilities conducting testing in that stale must be owned by a New Jersey-licensed physician, with all tests to be interpreted by a New Jersey plenary licensed physician. Such a ruling completely negates the benefits that such techniques marvel, and that the Internet and video-conferencing can provide to patients and physician specialists separated by hundreds of miles. But this decision is definitely and presently under appeal. TAC: Since you are, nevertheless, being linked with this case (by the media, if not by the courts), as if you were a principal, was the MI) in the Sehick case used to sign forms that allowed the clinic to collect insurance money that would not otherwise have been paid to DCs? DHD: Again. I cannot tell you exactly what was really going on in the Schick clinic, since he has never been a client and I have never even met him. But. apparently, the medical doctor, basically, billed for the services that he rendered, and the chiropractor billed for the services that he rendered separate- In the multidisciplinary clinic, it really depends how the treatment protocols are instituted. The patient walks into the clinic and the doctor in charge makes the decision as to what type of treatment is necessary. The patient is then sent to the various departments that are needed to render services, and these services are billed accordingly. It is obvious that, since more services have been rendered, billing will increase and. thus, will collections. TAC: Do you know whether acceptable S.O.A.P. notes were kept on all patients, in this case? DHD: Again. 1 don't know. But. documentation, obviously, is an extremely important part of any center, even more so when multiple physicians of various disciplines are involved in working together all under one roof. In our multidisciplinary clinics, doctors are taught how to take extensive notes, as well as document all necessary information to render the proper treatment. TAC: Are your clients' MD/DC practices truly integrated or are they, as often implied in the media, formed as a joint effort, simply as a way of billing the insurance company for services not otherwise authorized? DHD: Multidisciplinary clinics are set up to promote as many services as the clinic has to offer. In a truly integrated practice, the patient is given a thorough examination and a completely holistic approach is taken. The patient has the option to accept the complete treatment and the recommendations of the doctor of record, or simply to request limited treatment. It is not unusual for patients to come into a multidiscipline clinic and receive only chiropractic care or, sometimes, strictly medical care, or a combination of both, depending on the patient's needs. Hence, the billing will increase. Coverage for these treatments is always verified in advance. Insurance companies, obviously, reserve the right to pay or not to pay tor such service. TAC: Do you feel that the multidis-ciplinary practice concept is in jeopardy, at this time, in the United States? DHD: Multidisciplinary clinics have been alive and successful for decades. I. personally, practiced in my very own successful clinic for many years. The fact that many doctors in the last couple of years, unfortunately coached by greedy incompetent consultants, have been given erroneous fraudulent information has nothing to do at all with the multidisciplinary goals. TAC: Do you think the profession is supportive of your concept of multi- disciplinary practice? DHD: Aside from a lew very narrow minded doctors out there. I believe that the majority of healthcare practitioners believe that the art of healing is a combination of dedication, expertise, knowledge, teamwork, kindness, compassion, hard work, and love. The end-result to any healthcare center should be. and must be. the need to give the patient the most thorough, genuine, unadulterated care possible. TAC: As an expert in this field, what is your advice to doctors currently operating in such practices, as well as those considering converting to a multidisciplinary clinic? DHD: First is to know and understand the reason why the clinic was converted into an integrated practice. If this whole process was done strictly in order to defraud the insurance companies and/or increase the clinic's revenues, then the clinic should be shut down immediately. It is of the utmost importance that this concept be done in an attempt to provide to each patient the best care possible in one location, using the expertise of several adept professionals in the most legal way available. It is also extremely important for each doctor to know and understand that understanding and knowing how to run a successful multi-disciplinary clinic are two very different issues. This concept is constantly changing, and it is extremely important for everyone to be sure that a reputable and extremely well versed consulting firm be used. Just as well, the doctor needs to be sure that a competent healthcare attorney constantly j reviews and keeps up to date with the ever-growing changes j which exist in the health Held today. I have no doubt in my \ mind that the multidisciplinary clinic is "the wave of the I future". In this day and age. practicing requires more work than it did 10 years ago. MD/DC clinics require even more tedious attention to multiple details, and a very careful and focused energy, given the recent changes in health care requirements, specifically, from the Health Insurance Portability and Accountability Act (H1PA). which was released in December 2000, stating that every healthcare provider MUST have a compliance program in place and be ready to submit compliance reports. In other words, any entity which has access to patient information must deal with these regulations or face legal sanctions. Every single Practice Perfect client has had a compliance program in place since two months prior to this regulation. However, in an attempt to maximize all benefits and optimize all results, while rendering the best of care, an honest doctor can, indeed, integrate his clinic into an incredible healthcare facility. And, even though, at times, we read about these investigations which imply that this concept is. indeed, becoming "dangerous", the answer is absolutely not true. Indeed, one has to remember that, when one door closes, another opens. But, we often look so long and so regretfully upon the closed door, that we do not see the one which has opened for us. This is an opportunity to be at the forefront of healthcare history, and I know, in my heart, that, given the fact that we are truly dedicated to this development, we will indeed succeed. Dr. Daniel H. Dalian can be reached at 800-598-6289 or at [email protected]. Website: www.dahan.coin. ■
