A Doctors Challenge
PERSPECTIVE
A true story, from Pekin Camp From Adversity to Strength
Part I
By Dr. Anthony Calandro
Iam writing this, while I have a few more weeks to serve here at the Pekin Camp, Ill., looking out at the woods from the library window. This experience is something I want to share with all doctors, their families, and staff—that it can happen to you as easy as getting a speeding ticket, and I want to prevent this from ever happening through my experience and the knowledge I gained. As a practicing physician for 32 years, and although noted as having one of the top 3 solo personal injury practices in Missouri, serving on the Board of Trustees over 9 plus years, serving on the Alumni Board for over 17 years, being a former member of the Missouri State Board of Chiropractic Examiners, and a frequent guest lecturer from time to time at our chiropractic university on practice success, you are still at the mercy of the federal government or other authorities with audits, and it can happen at any time, any day, and even if they don 7 like you!
My unique situation was standing up for our profession and my patients rights for years for the care and benefits they had rightfully paid for. There were, as most doctors, in their practices know, on the business end, many discriminating practices by the covering entities, claiming that treatment was not necessary or unreasonable and also wanting unnecessary documentation over and over again, which prevented us from administering health care and denying our patients the benefits they paid for.
I decided to take a stand andfight back. As a result, I hired a young aggressive attorney to be on staff and represent us and our patients through an authorization with an Assignment Agreement form, which basically took 4 steps to accomplish. You can get this information at "doctorspersonalinjuryonline. com. "
We were so successful that we filed over 108 discriminatory claims over the past 4 years, protecting our profession and patients. We won every one of them, except for 1 that was thrown out and dismissed.
“At approximately 10:07 a.m., several FBI agents stormed the office as if there was a hostage crisis!
Since we have a 4-story building,
I promptly asked “What was going on in the building?”, and they said, “We are taking over your office for an investigation, 5 5
Facts Leading to Why the FBI Had an Interest
I continued to stand up for our profession and our patients rights. We came up against one particular company that had a hired consultant from our own profession, who, we found out through a background check, was not a practicing doctor but had acquired an office at the insurance company’s address.
■ "They kept asking for the files and saying that an attorney and patient weren’t necessary and that they could review any files they wanted without them. 5 5
My attorney caught on to their tactic of asking several doctors at random for a number of files and they reviewed the documentation of these files. If some professional services in these files were not indicated to their liking, but were actually done, the doctors were told that the services were unnecessary, and they were overpaid and demanded a refund of the benefits rightfully earned for providing the services.
When asked for our files, at the bequest of our attorney, we took a stand and requested that my attorney and the patient to be present in person while they reviewed the files, to answer any questions, to prove to them that all services were rendered. They kept asking for the files and saying that an attorney and patient weren’t necessary and that they could review any files they wanted without them. I refused each time, and this is where the resistance began. Based on these
facts alone, the consultant started what my attorney referred to as a target investigation.
Actual FBI Raid, the Experience of What Happened When They Entered on the Day of Practice
On December 1st, 2011, the day started with a prayer and motivational messages to our staff. At 9:30 a.m. we started seeing our patients for their health care. We had about 12-14 patients in the office at that time. At approximately 10:07 a.m., several FBI agents stormed the office as if there was a hostage crisis! Since we have a 4-story building, I promptly asked “What was going on in the building?”, and they said, “We are taking over your office for an investigation,” and handed me a search warrant. They escorted all the patients out unless they wanted to be questioned. The staff was told to close the office, and I was asked to leave till they were finished. Basically they took all the files, computers, and tapped the phones and email for our conversations in the future.
We were being investigated for our practices of billing and they took what they needed to conduct the investigation and left around 2:30 p.m. that same day. We did put the office together, and we were able to return and start the afternoon patient schedule. We were all perplexed at what had just happened. This experience proves that an office investigation can happen at any time and on any day. I called my attorney and
told him what had happened, and he informed me he would try to find out what exactly their motive was and to find out why. There was some relief, but we were totally caught off guard and wondered what we or the practice did.
Facts Found in the Practice by the Federal Government and Other Facts They Looked for in the Investigation
For the most part, the first step was a series of questions to our staff, patients, and especially directed to me, as the practice corporation owner and only doctor. My attorney did finally find out and informed me that the federal government was mostly looking for a consistency in a possible coding system we were using in the practice. Little did we know the FBI planted 3 undercover agents as patients and we did provide our services to them professionally. The federal government did use these audio and video presentations later when we went to trial.
They were compiling facts in the coding compliance area in 3 particular areas through our software. Our X-ray codes in which they decided what we coded was not compatible with what they had through the AMA coding. Our practice code presented a lumbar bending code, and they presented a lumbar bending with 4 views with the same code, our routine procedure was to take 2 X-rays of the anatomical area involved by positive tests.
The brief service code we used, they noted, was misused, as we used it for telephone consultations, follow-up services by phone and other small services rendered professionally. They informed us the description noted the patients were to be seen in the office to be rendered the service.
Also, by recommendation of the established professional company we used a whirlpool code for our dry whirlpool water therapy bed service, in which they also used fraudulent codes against us, even though we did use water but encapsulated. The federal government informed us the code we were using stated we needed to actually put the patient in the water.
Basically, the descriptions were not perfectly matched with the service performed and not documented properly for the most part, which caused the compliance fraud. So we were subject to being charged with misrepresentation coding fraud.
Look for Part II in our next issue.
Dr Anthony Calandro, DC, has practiced 32 Years in St Louis Mo. He is an author, a motivator, and has served on many boards in the community. He nows shares his emotional life experience to help other professionals. He has been scheduled to speak to many major conventions, state associations and compliance companies. Please contact "Share Success Sessions"at 314583-8910 or E-Mail nickcalandro@yahoo. com for speaking engagements or information.
