Friday, July 27, 2012

Banning the Criminal Activity Makes the Criminal More Sophisticated

In 2003 the California legislature passed SB 228.

Among its various controversial provisions was a constriction on the number of chiropractic visits an injured worker was entitled to.

This law was implemented because some chiropractors would take advantage of workers' compensation's life long medical care provision and have patients on weekly adjustment programs for years, running up chiropractic bills in the tens of thousands of dollars per case.

But to prove that as soon as you shut down a well another spigot opens up (or, since this is county fair season in California, "Whack-A-Mole") unscrupulous chiropractors have teamed up with similarly characterized physicians to take advantage of the law in complex schemes to continue unfair profiteering, and according to some, illegally bilking the work comp system, and other medical systems.

California law allows licensed professionals, such as chiropractors, acupuncturists, registered nurses and doctors of podiatric medicine, to own up to 49% of medical corporations. A physician or physicians who are licensed by the Medical Board of California must own at least 51% of the corporation. California Corporations Code Section 13401.5 further says the number of licensed professionals can’t exceed the number of licensed physicians in a medical corporation.

These are known as multidisciplinary clinics and allow patients to go to a single clinic to get all the treatment they need under one roof - which would seem like a great, convenient model for patient convenience.

Chiropractors intent on unfair business practices however "lease" the use of doctors' name and licenses for medical clinics to take advantage of this liberality.

Using what's known as the MD-DC model, chiropractors get around the SB 228 constriction by having physicians order up services and make referrals for unnecessary procedures.

Several fraud experts who talked to WorkCompCentral on the condition that their names not be published said that multidisciplinary clinics -- and the MD-DC model in particular -- have become more prevalent in California after the implementation of Senate Bill 228 in 2003 and are responsible for highly inflated, if not outright fraudulent, medical billings.

But these schemes are notoriously difficult, and expensive, to prove in a court of law because of the sophistication that these people use in their accounting and other records.

And while the criminal aspect of these enterprises is alarming, the truly shocking element is that these people have no regard for the patients that are subjected to "treatments" in the name of ill-gotten gains.

For instance, the Division of Workers' Compensation (DWC) suspended the Qualified Medical Examiner (QME) license of chiropractor Richard Skala for six months but stayed the suspension and placed him on probation from July 25, 2011, through Jan. 24, 2012.

The violation Skala was accused of was referral of patients to the 51% owner of Golden State Neuro Medical Association Inc., Ramanathan Prakash, to conduct “nerve conduction velocity testing” on four occasions between March 11, 2008, and May 20, 2009. DWC says in its complaint that these referrals were made for profit in violation of Labor Code section 139.3.

Skala was a partner in Golden State Neuro Medical Association Inc. Prakash's QME status was terminated in 2011 for not reporting that he held an ownership interest in the medical practice.

Prakash was eventually found guilty of MediCare fraud for participating in a scheme that falsified patient records and billings.

All of which shows that you can ban the criminal activity, but you can't remove the criminals.

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