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ISCA Report

July/August 2008

President's Message Dr. Duane Binder, D.C. It’s hard to imagine that Spring has lasted so long and now Summer is upon us. As with so many things, time seems to keep going by so fast anymore. Regardless of our position, things keep changing and so must we as an Association. The ISCA Board of Directors will be holding a meeting in July to discuss regular business but also to have a strategic planning session. This planning session is to lay out some short term and long term goals for the ISCA as well. We need to determine realistic goals for the next year, as well as the next 5 and 10 years regarding our position in membership services, political agenda and public awareness of Chiropractic services and benefits. These are but a few topics for discussion. Just like operating your individual offices, we need realistic goals for the operation of the ISCA. The Board of Directors needs input from all members so please provide any suggestions you might have to your District Representative, Executive Committee or the ISCA staff. The strategic planning session is important for the continued success of the ISCA. Along this line, the ISCA needs members to assist with their time and resources to accomplish these goals. We have made numerous changes this past year and we must not rest on our laurels. The ISCA is in constant need of members to serve on committees, attend functions and participate in meetings. Our Association is more than a handful of people so get involved and keep abreast of information that is distributed through

our newsletter, web site and email communications. Several members of the Insurance Committee have met with Anthem. They are attempting to clarify various areas of confusion and policies with Anthem relating to audits and documentation. Executive Director, Pat McGuffey, will be providing more information on the outcome of this meeting. Planning for the Fall Conference and even next Spring (2009) has been remarkably successful with a good slate of speakers on various topics that will benefit your practice. I wish to thank Dr. Sheila Wilson and Mr. Lane Velayo for their coordination of those efforts. Unfortunately, I have received several complaints about Doctors that have decided to participate in some questionable business practices relating to employees and employee/patients as well as some advertising issues. Fortunately, those complaints were not regarding any ISCA members. Some of these practices may be legal but the ethics are questionable. An old saying: “Do unto others as you would have them do unto you.” This can go a long way to earn respect for you. Now that I have rambled on, in closing, I am very proud of the ISCA Board of Directors and LMV consulting for the changes that they have brought forth. They are making big strides to help you in daily practice by doing the little things that make a big difference.

Inside This Issue President's Message..................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Executive Director's Message................................................................3 Parts of Indiana & Iowa Declared public health emergency........4 Don't Forget: Medicare Providers Use only Npi #'s on claims......4 David Jose Legal Column...........................................................................6 Cocsa member spotlight............................................................................6 GOod Morning America Discusses Chiro Hypertension...............7 AAMLP: A New National Org. Welcoming Membership.....................8 Rule that defines allowable charges...................................................8

July/August 2008

Eligibility for Chiro Benefit in Armed forces..............................9 ACA voices strong opposition to Ama Resolution..............................9 Study: Golf is good for you...................................................................10 ISCA Annual golf outing...........................................................................11 Improving health care is critical challenge.....................................12 What It means to 'keep inviolate"........................................................13 What does OIG Investigate?....................................................................14 Report says Antioxidants Do not Prevent Mortality.......................15 ISCA Fall Conference..................................................................................16 ISCA Classifieds......................................................................................18-19

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Indiana State chiropractic association Board of directors President Duane Binder, D.C. Clinton, IN 765.832.7777 Dbinder326@aol.com First Vice-President Peter Furno, D.C. Zionsville, IN 317.338.6464 pfurno@sbcglobal.net

G. Matt Howard III, D.C. Muncie, IN 765.254.9481 mattjoanhoward@hotmail.com Michael, Phelps, D.C. Martinsville, IN 765.342.2208 mchiro@reliable-net.net

District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989 vuotto@insightbb.com

District Directors

District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 Flopper1968@hotmail.com

Second Vice-President Ray Nanko, D.C. Muncie, IN 765.288.3276 nankomd@ameritech.net

District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900 reddcdr@comcast.com

District Nine Nate Unterseher, D.C. Seymour, IN 812.522.2240 drn8@live.com

Secretary Marian Klaes-Lanham, D.C. Seymour, IN 812.522.2240 drmarian@klaesclinic.com

District Two Gerald Hofferth, D.C. South Bend, IN 219.484.1964

Alternate Directors at Large

Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355 cwbdc@aol.com Immediate Past President Anthony Wolf, D.C. Indianapolis, IN 317.898.1100 Drtony6900@aol.com Past President Representative Mick Gallagher, D.C. Indianapolis, IN 317.571.1480 MGalla6425@aol.com Directors at Large Ted Friedline, D.C. Salem, IN 812.883.1444 Sp9dr@comcast.net

District Three James Cox II, D.C. Fort Wayne, IN 260.484.1964 Cox.chiropractic@verizon.net District Four G. Lyman Shaw, D.C. Brownsburg, IN 317.852.3870 glshaw@juno.com District Five Derek Dyer, D.C. Huntington, In 260.356.1616 nddyerd@yahoo.com District Six Robert Tennant, D.C. Shirley, IN 765.737.1117 doct@hrtc.net

Terry Tolle, D.C. Greensburg, IN 812.663.7640 drspine26@yahoo.com John Volbers Indianapolis, IN 317.299.3330 ecchiro@cs.com Alternate District Directors District One Lewis Myers Valparaiso, IN 219.464.4444 District Two Vacant District Three Vacant District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885

gtdlf@netcapade.com District Five Vacant District Six Stephen Frank, D.C. Anderson, IN 765.641.7700 sdfrank@insightbb.com District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 indysportdoc@iquest.net District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com District Nine John Krawchinson D.C. Seymour, IN 812.524.2273 Alternates: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate District Directors are nominated and then must be approved by the Board of Directors. The Alternate District Directors at Large are recommended by the Directors at Large and approved by the board.

Indiana State chiropractic association staff & Info

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Patricia McGuffey Executive Director pmcguffey@lmvconsulting.com

Stephanie Higgins Director of Events shiggins@lmvconsulting.com

Patrick Russell Executive Assistant prussell@lmvconsulting.com

Lane Velayo Association Manager lvelayo@lmvconsulting.com

Stacy Quasebarth Director of Communications squasebarth@lmvconsulting.com

Krista Rader Receptionist krader@lmvconsulting.com

Tom Johnson Chief Finanical Officer tjohnson@lmvconsulting.com

Connie Vickery Governmental Affairs cvickery@lmvconsulting.com

Debra Scott Vice President of Operations dscott@lmvconsulting.com

John Livengood Governmental Affairs jlivengood@lmvconsulting.com

ISCA Report

200 S. Meridian St., Suite 350 Indianapolis, IN 46225 info@indianastatechiros.org www.indianastatechiros.org 317.673.4245 phone 317.673.4210 fax

July/August 2008


Executive Director's Message Patricia McGuffey

ANOTHER MEETING WITH ANTHEM ISCA met again with Anthem as a follow-up to the many issues we raised at our previous meeting and outlined for you in earlier newsletters. Anthem seemed a little more receptive to our concerns at this meeting. I will list the agenda items below and summarize our discussion. 1. Decreasing Reimbursement Rates. a) When is Anthems next review? b) Do you accept any outside input? ISCA reiterated our ongoing concerns over reimbursement reductions vs. DCs' overhead increases. In addition, we asked if we could have input when they did their next review to determine rates. Linda Barabee indicated that DCs can have input by contacting her or their local Anthem consultants. She indicated it would be useful if you would write her or your local Anthem consultant and list specific codes and what it costs to deliver the service vs. what you are receiving. The implication is that this information would demonstrate how the reimbursement rate is not covering costs. Dr. Peter Furno gave Anthem a summary of Anthem’s reimbursement decreases from 1998 through 2007. Thoracic, lumbar, and cervical X-Ray reimbursements have all decreased almost 50%. Extraspinal Manipulation is down 31%, Spinal Manipulations – 5 regions is down 18% and traction reimbursement has decreased by 50 percent. I WOULD LIKE EVERY MEMBER OF ISCA TO CONTACT LINDA BARABEE AT THE FOLLOWING ADDRESS OR E-MAIL AND COPY YOUR LOCAL CONSULTANT WITH THE INFORMATION REQUESTED ON REIMBURSEMENT PROBLEMS DETAILED ABOVE. WE MUST LET ANTHEM KNOW OUR PROBLEM IS WIDESPREAD! Contact information for Linda Barrabee: P.O. Box 7101 Indianapolis, IN 46207 or Linda.Barrabee@anthem.com 2. Medical Necessity. a) How are you determining / defining Medical Necessity b) What documentation specifically are you using to determine if the treatment / therapy is medical necessity – duration of care, prepayment review? c) What can our clinicians do to improve to demonstrate Medical Necessity? 3. Experimental or Investigational Therapies. a) What procedures are considered investigational or experimental b) How are these treatment or therapies determined investigational or experimental c) How do you notify the clinicians 4. Audits. a) Identify Reason b) Identify Target Areas c) Quality Improvement to avoid – post payment Refunds d) Medicare Template – can we assume this is the information you need for documentation?

July/August 2008

The answers to the above agenda items were addressed by Howard Levinson, DC, who works with Anthem in Special Investigations. He presented a written slide presentation that detailed the things he looks for in quality improvement and audits. He indicated that Quality improvement studies were sometimes in response to claims analysis data studies that reveal a provider’s practice patterns are substantially different than his/her peers. Also, he reported that they also responded to Hotline tips and internal referrals from claims processing, etc. Some of the things he looks at are increased frequency of EM’s in relation to EM/CMT/TPC, increased frequency of 98942 and of Therapeutic Procedure Codes (TPC) as well as 97140. Dr Levinson reported the following information regarding recent audits and the process used. He stated that his charge was to evaluate claims categorized as “out-liers” for “reasonable” Medical Necessity, and correlated the patient history with the examination findings and the diagnosis. He said on more than one occasion that “if it wasn’t written down, it wasn’t done”! He was somewhat hesitant in defining for us the term “Medical Necessity”, inasmuch as he considered the definition on a case-by-case basis and did not want to hamper his authority by issuing a concise and perhaps restrictive definition that could be misconstrued. He appeared to prefer the resorting to the appeals process for those cases the practitioner disagreed with. Recent Audits EM audit of approximately 1000 IN DC’s submitting claims to Anthem • 2X average of EM claims for peers • 42 IN DC’s received medical record requests for 10 EM records to substantiate EM was performed, coded correctly & was medically necessary • In some cases, Providers were substituting EM for CMT, or CMT and PT. TPC audit of approximately 1000 IN DC’s submitting claims to Anthem • 2X average of TPC claims of peers • 37 DC’s received medical record request for 10 TPC services to document services performed • In some cases, Providers were substituting TPC codes for CMT. • In some cases, services not documented adequately or not at all. CMT 98942 audit of approximately 1000 IN DC’s submitting claims to Anthem • 4X average of 98942 claims of peers • 56 DC’s received medical record requests for 10 CMT services • Some offices at 100% 98942 • Computer billing all CMT at 98942, coding errors, provider misunderstood spinal regions. Results of Recent Audits • Medical records support the high frequency EM – e.g.: acute care practice of perhaps exam doctor • Medical records support high frequency of TPC (rehab practice) • Medical records support the full spine adjusting with (Executive Director's Message Continued on Next Page...)

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Executive Director's Message Continued.... • • • • • •

documentation of 5 regions and medical necessity. Medical records inadequate to support service billed Illegible Too brief Computerized templates No records sent

Ongoing Audit Process • Review received medical records • Send 2nd record request to non responders • Re-evaluate claims data pre vs. post notification to ID change in behavior • Identify providers whose behavior did not change • Referral of egregious providers to investigate unit Other Recent Audits • Spinal Decompression billed as PT or using surgical nerve decomp codes • Musculoskeletal Diagnostic Ultrasound • Multiple MRI’s per patient per day at Mobile MRI facility • Mobile Dx Company – sEMH, NCV, US • Manual Therapy Initiative CPT 97140 • Claims analysis of high frequency claims for manual therapy • Providers who were 3X peer average received a notification. • DC, PT, OT, MD, DO, DPM • Ten (10) DC’s received an informative letter defining appropriate coding for 97140. (no medical record request) Anthem did indicate that they listed investigational and experimental therapies not reimbursed on their web site at http:// www.anthem.com/home-providers.html, as well as all medical policies. Also, they suggested you sign up to get notices on changes in their practices and that you would receive their newsletter as well. Dr. Howard Levinson, D.C. can be contacted at 1-800-3928740 ext. 36203 or howard.levinson@wellpoint.com. 5.Delay(s) in reimbursement. ISCA gave Anthem examples of reimbursement delays before the meeting and Linda Barrabee indicated they were working to solve the specific problems as well as attempting to rectify all problems. Please contact your local Anthem consultant and/or notify Linda Barrabee if you have problems with delayed reimbursement. In addition, Anthem’s attorney has asked us to send a letter detailing all claims processing issues our members have. Please let us know of problems so we may pass those along to Anthem to address. 6. 97140 Deep Muscle Therapy or 97124 Massage Therapy. Anthem indicated they did not believe it was a problem for DCs to get reimbursed in Indiana for DC directed massage therapy. However, they intend to double check on this. They indicated they thought this was an issue only for KY. 7. Use of Chiropractic Assistants to perform therapy services under the Supervising Physician. Once again the same answer as above. Anthem will investigate but there should not be a problem with DC directed services. 8. Anthem's provider telephone lines are not answering questions. Anthem promised to look into this and rectify the problem.

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9. Request for Anthem to do educational conference for ISCA. Anthem indicated they are willing to do a workshop either at our Fall Conference or at a special seminar to educate our DCs on proper documentation which they propose is the major problem DCs have with claim denials and audits. They will also investigate if they can utilize a similar evaluating form to that utilized by Medicare (provided by Dr Nanko), which approaches claims evaluation in a logical, sequential manner TASK FORCE MEETS AGAIN TO DISCUSS ASSIGNMENT OF BENEFITS (AOB) I attended another meeting to discuss the AOB proposed legislation. ISCA provided studies and information to demonstrate the importance of AOB and the fact that it does not increase healthcare costs or denigrate healthcare networks. However, insurance representatives continue to vehemently oppose this issue based on their rhetoric that it will increase healthcare premiums, etc. The Chairman set another meeting for July. It appears this Task Force may recommend an independent neutral entity should study the AOB issue to determine what the results are with States that have implemented AOB legislation. I will keep you posted. BUSY TIMES AT ISCA OFFICE We are busy at the ISCA office planning for our July Board meeting and strategy planning session, the golf outing, fall conference, etc. Please become involved in your ISCA as we need all of our members to be active. Please feel free to visit the ISCA web site for updated information or email me at pmcguffey@lmvconsulting.com or 317-673-4245 if I can be of assistance.

Secretary Leavitt Declares Parts of Indiana and Iowa Public Health Emergency The floods that plagued Iowa and Indiana in June have prompted Secretary of Health and Human Services Mike Leavitt to declare a public health emergency in the affected areas. Rising flood waters have forced many Medicare beneficiaries to evacuate to neighboring areas. Some of the health care facilities in those areas do not have access to the beneficiaries’ health records and have limited information on current health standings and even Medicare enrollment status. In this circumstance, the Centers for Medicare and Medicaid Services (CMS) is waiving the normal burden of documentation and allowing providers to perform under a presumption of eligibility. This declared state of emergency allows Medicare providers and beneficiaries greater flexibility in meeting medical emergency needs.

ISCA Report

July/August 2008


75% of Americans use the internet every day. Are you still using paper charts and plastic models to educate your patients? Virtual ConsultationTM

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Schedule a Live Demonstration at www.commvantage.com or call 866-399-4009 for more information July/August 2008

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Supreme Court Issues Opinion on noncompetition agreements Submitted By: Dr. David E. Jose, Esq., Krieg Devault LLP Phone: 317.238.6211 Email: djose@kdlegal.com Website: www.kdlegal.com

The Indiana Supreme Court recently issued an important opinion that will have an effect on the application and enforcement of non-competition agreements in Indiana, especially among health care providers. The case involved a podiatrist who was employed from 1996 until 2005 by Central Indiana Podiatry, P.C. (“CIP”). The decision contained a lengthy discussion of the facts and the law by the Indiana Supreme Court, so it is particularly important. As a basic principle, the Supreme Court held that noncompetition agreements between a physician and a medical practice group are not automatically void as against public policy. They may be used and they may be enforceable to the extent that they are “reasonable”. It is the concept of “reasonableness” that can provide many complications and uncertainties in this area. Each case is very fact-sensitive and needs to be evaluated in light of the specific facts and circumstances for the individual and the employer group. The Supreme Court began by noting that the relationship between a health care provider and a patient is different from a typical business in which a court would be reviewing a noncompetition agreement between an employee and employer. In a health care setting, the noncompetition agreement affects the patients’ legitimate interest in selecting the physician of their choice, so the terms and conditions of the noncompetition agreement will receive special scrutiny. In this case, the employment agreement stated that the geographic area for the noncompetition agreement would extend to all of the counties in which CIP had offices, along with adjoining counties. It was important that the employer used “counties” as the basis for the geographic area rather than a mileage radius. CIP operated offices in many counties throughout Indiana, but the principal office in which the podiatrist worked was in northern Marion County. Although the podiatrist was seeing patients from the southern part of Hamilton County, the Supreme Court held that it would be unreasonable to assume that the podiatrist was seeing patients from the distant parts of Hamilton County. Since it would be unreasonable to extend the restrictive covenant to all of Hamilton County, the Supreme Court would not extend the restriction to any of Hamilton County. So, the geographic restriction was limited to Marion County and did not include all of the adjoining county. The Supreme Court limited the application of the geographic area to that office or those offices in which the podiatrist actually practiced. The Court did not extend the geographic area to any other counties in which CIP had offices since the podiatrist had not practiced in those other locations. Many employers often seek to tie the restricted geographic area to all of the locations where it operates. Thus, employers will need to carefully consider the impact of this limitation. Another point to note is that the Supreme Court only looked at where the podiatrist had worked for two years prior to the termination of the relationship. This corrolated with the fact that the period of time covered by the restrictive covenant was for two years following the termination of the relationship. Again, this is an important development since many restrictive covenants have been drafted to cover any location where the professional may have worked during the entire period of time he or she was employed by the employer. There are several other important findings and comments within the Supreme Court’s decision. All of this reinforces the challenges that are present in drafting and negotiating a fair and enforceable noncompetition agreement between a professional practice and an individual professional. Each situation must be evaluated on its own merits, and this recent decision by the Indiana Supreme Court must be given careful consideration. If you have any questions regarding this new decision, or with respect to employment and noncompetition agreements generally, please contact David E. Jose at (317) 238-6211 or djose@kdlegal.com.

COCSA Member Spotlight...

From: Dr Sig Miller Executive Director - Association of New Jersey Chiropractors The New Jersey Supreme Court issued its decision in the extraspinal adjustment case of Bedford v. Riello. The Court, with two justices dissenting, held that the chiropractic scope regulations "permit manipulation of articulations beyond those of the spine when there is a causal nexus between a condition of the manipulated structure and a condition of the spine." The Court further held that, "Whether adjustment of a particular portion of the body is permissible as a "related structure" under the rule must be determined and demonstrated by the practitioner on a case-by-case basis, focusing on whether a condition to the adjusted structure bears a causal relationship to a condition of the spine." This is a resounding victory for all chiropractors in New Jersey as well as other states who have been closely monitoring this precedential case. The case was remanded for retrial on the malpractice issue but the decision became effective June 18, 2008, permitting chiropractors to adjust extraspinal areas provided they document a causal nexus to a condition of the spine. Congratulations to the ANJC legal team of Leardi, Randolph, and Buttacci as well as Mary Ann Nobile who argued the case before the Supreme Court for the defendant chiropractors.

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ISCA Report

July/August 2008


‘Good Morning America’ Medical Editor Discusses Chiropractic Hypertension

Call to Action: Tell Congress to Stop Medicare Physician Fee Schedule Cut Article by: Dr. Robert Tenant

ABC’s “Good Morning America” recently reported on a University of Chicago study that found a possible connection between chiropractic cervical manipulation and a decrease in blood pressure. The study, published in the Journal of Human Hypertension, reported that patients who received chiropractic adjustments saw their blood pressure drop an average of 17 points – a dip that usually requires two blood pressure medications to achieve. The study does have its limitations, however, including its small sample size. In the original study, only 50 patients were treated 925 received a real adjustment, while the other received a placebo). A larger study has been commissioned. During the “Good Morning America” segment, which aired in late March, ABC News medical editor Tim Johnson, MD, said “This [research] catches our attention because of a significant drop in blood pressure. It absolutely deserves more study.” Watch the “Good Morning America” segment on the ACA website at www.acatoday.org/InTheNews.

July/August 2008

10.6% cut starting July 1.

Last December, Congress passed legislation that would stave off a 10% across-the-board cut to the Medicare physician fee schedule (MPFS). Provisions within the bill essentially replaced the cut and provide a slight overall increase of 0.5%. These provisions, however, expire on June 30, and if Congress does not act before then, all Medicare providers will face a

While Congress is exploring alternatives to the fee cuts (see story above), ACA urges DCs, CAs, students, patients and other friends of chiropractic to immediately contact their Senators and Representatives in Congress and encourage them to look critically at Medicare physician reimbursement and work with their peers to develop a policy solution that addresses the impending cuts. Senators and Representatives should also be sure that any policy solution takes into consideration the status of all providers in the healthcare community, including non-MD practitioners.

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AMERICAN ACADEMY OF MEDICAL LEGAL PROFESSIONALS: A new national organization welcoming membership The Academy is a national, non-profit organization approved by the New York State Department of Education and has developed a collaborative effort between medical and legal professionals in an ethical relationship. The purpose is to support, on a national level, through research, dialogue and clinical excellence, those that work in the medial-legal arena, to further support the care of patients and to foster working relationships between the 2 professions. The Chairman of the Board of the Academy is Mark Studin DC, a chiropractor for 28 years who has been working tirelessly for chiropractic his entire career. The President of the organization is Bill Owens DC, of Buffalo NY, who is the publisher of a medical-legal research publication that has educated the legal community nationwide. The balance of the board is comprised of Medical Doctors and Attorneys. The Academy is accepting doctors of chiropractic as members and is offering Diplomate status for qualified practitioners. Once conferred, the doctor will be able to add the credential of DAAMLP after their DC, if they so choose. The Academy offers extensive support in the areas important to the medical-legal practitioner. The most important factor in delivering effective care to the traumatically injured is communication. The Academy puts you in contact with practitioners on both sides of the medical-legal arena while providing a foundation to promote relationships within your own community. The Academy provides a platform of peer-reviewed, medically indexed research reviews and medical-legal information to benefit the patient. Membership benefits include a medical review library, the case law library, press releases to each member’s community promoting the member’s practice, and our Diplomate program signifying clinical excellence. The Academy also supports members with research that can be utilized to certify medical necessity (when clinically indicated) in overcoming Peer Reviews and IME rejections that are based in fiction. To join the Academy or to find out more, please check out the official site of the American Academy of Medical Legal Professionals at www. aamlp.org or call Dr. Bill Owens 716-228-3847.

Rule That defines allowable charges for copying health records Rule 71. Copies of Medical Records 760 IAC 1-71-1 Applicability and scope Authority: IC 16-39-9-4 Affected: IC 16-39 Sec. 1. This rule applies to all providers and medical records companies. (Department of Insurance; 760 IAC 1-71-1; filed Sep 14, 2005, 2:45 p.m.: 29 IR 547) 760 IAC 1-71-2 Definitions Authority: IC 16-39-9-4 Affected: IC 16-18-2-295; IC 16-39 Sec. 2. The following definitions apply throughout this rule: (1) "Medical records company" means a company that contracts with providers to make copies of patient medical records. (2) "Provider" has the meaning set forth in IC 16-18-2-295. (Department of Insurance; 760 IAC 1-71-2; filed Sep 14, 2005, 2:45 p.m.: 29 IR 547) 760 IAC 1-71-3 General requirements Authority: IC 16-39-9-4 Affected: IC 16-39 Sec. 3. (a) A provider or medical records company that receives a request for a copy of a patient's medical record shall charge not more than the following: (1) One dollar ($1) per page for the first ten (10) pages. (2) Fifty cents ($.50) per page for pages eleven (11) through fifty (50). (3) Twenty-five cents ($.25) per page for pages fifty-one (51) and higher. (b) The provider or the medical records company may collect a labor fee not to exceed twenty dollars ($20). If the provider

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or medical records company collects a labor fee, the provider or medical records company may not charge for making and providing copies of the first ten (10) pages of a medical record. (c) The provider or medical records company may charge the actual costs of mailing the medical record. (d) The provider or the medical records company may collect an additional ten dollars ($10) if the request is for copies to be provided within two (2) working days. (e) The provider or medical records company may collect a charge not to exceed twenty dollars ($20) for certifying a patient's medical record. (Department of Insurance; 760 IAC 1-71-3; filed Sep 14, 2005, 2:45 p.m.: 29 IR 547) DEPARTMENT OF INSURANCE Indiana Administrative Code Page 314 760 IAC 1-71-4 Waiver of charges Authority: IC 16-39-9-4 Affected: IC 16-39 Sec. 4. A provider or a medical records company shall consider waiving or reducing the charges for copies of a patient's medical record under the following situations: (1) A request from a provider: (A) to whom the patient was referred for treatment; or (B) from whom the patient is seeking a second opinion. (2) The patient requested the records for his or her own use, and the charges will cause an undue financial hardship upon the patient. (Department of Insurance; 760 IAC 1-71-4; filed Sep 14, 2005, 2:45 p.m.: 29 IR 547)

ISCA Report

July/August 2008


U.S. House of Representatives Strengthens Eligibility for Chiropractic Benefit in Armed Forces: Legislation seeks expanded access, overseas demonstration project The U.S. House of Representatives has approved a directive that orders the Pentagon to make chiropractic care a standard benefit for all active-duty military personnel. The legislation is contained in H.R. 5658, a bill authorizing defense programs in fiscal year 2009, and is based in part on recommendations from the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). The bill—passed by the Armed Services Committee on May 14 and the full House on May 22—also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic. “H.R. 5658 is a bipartisan bill that explicitly states that chiropractic is an integral component of the Pentagon’s health care delivery system, and it is the [Armed Services] committee’s intention that this language will increase access to chiropractic care at more facilities worldwide,” said ACA President Glenn Manceaux, DC. In 2000, Congress passed and the president signed a similar authorization bill, which contained language calling on the Secretary of Defense to develop a “plan” to get the chiropractic benefit to all active-duty service members. To date, there is a doctor of chiropractic at 49 military bases around the country; however, according to a 2005 Government Accountability Office report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. This most recent legislation shelves the “plan” approach and simply states that chiropractic care is a standard health care benefit. According to ACA sources, the House Armed Services committee also expressed concern that there were no doctors of chiropractic stationed at overseas military facilities. The language contained within H.R. 5658 allows the Pentagon to conduct demonstration projects to implement chiropractic care at these sites. “The House Armed Services Committee is to be commended for strengthening current law. This strong statement by the committee will pave the way for expanded access to this critical component of the military health care system—both here at home and overseas,” said ACC President Dr. Carl Cleveland III.

American Chiropractic Association Voices Strong Opposition to AMA Resolution The American Chiropractic Association (ACA) voiced strong opposition to American Medical Association (AMA) Resolution 232, which advocates the use of state legislation to make it a felony for non-MDs/DOs to misrepresent one’s self as a “physician.” Under federal statute, all doctors of chiropractic are considered physicians in Medicare and doctors of chiropractic are legally deemed chiropractic physicians in an overwhelming majority of states. ACA President Glenn Manceaux, DC, said the resolution serves only to discount the education of non-MD health professionals and will stifle competition within the health care marketplace. “The members of our Association are deeply concerned about the AMA’s most recent attempt to undermine the legitimate education and training of doctors of chiropractic as well as other health care providers,” Dr. Manceaux said. “It is not the role of organized medicine to regulate the titles and terminology used by other providers; it is the responsibility of federal and state legislators to bestow the title of ‘physician.’ As a trade association, the AMA is clearly overstepping its bounds.” Within the chiropractic profession, concern also exists that supporters of the resolution are acting in their own selfinterest at the expense of consumers, and that the new policy statement could jeopardize the inter-referral relationships many allied health providers—including doctors of chiropractic—have developed with their MD-counterparts. “At a time when health care costs are soaring, Americans deserve nothing less than an efficient health care system in which the contributions of all types of health care providers work in tandem to best meet the needs of our patients,” Dr. Manceaux noted. Resolution 232 was introduced during the AMA’s House of Delegates meeting. First brought forth by the Illinois delegation, the original resolution stated that the terms “doctor,” “resident,” and “residency” should be restricted for use only by medical doctors and it requested that these terms be protected through legislative efforts. The resolution was amended, however, to encourage state legislation to protect the term “physician” and to note that the AMA supports efforts on a state level to limit the term to MDs/DOs.

The ACA and ACC express their appreciation to members of the House Armed Services Committee, especially Reps. Neil Abercrombie (D-Hawaii), Mike Rogers (R-Ala.), Susan Davis (DCalif.), and John McHugh (R-N.Y.) for their work on this important military health care issue. The Senate is expected to take up the legislation in the near future. Watch ACA’s Web site http://www.amerchiro.org/ and publications for more details as they become available.

July/August 2008

ISCA Report

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Study: Golf is good for you From: Chiropractic Economics Issue 09 June 11th

You don’t have to feel guilty about taking Wednesday afternoon off to play golf. According to a new study from the Swedish medical university Karolinska Institutet, golf is good for you. In fact, it prolongs life expectancy, provided you walk the course instead of ride in a cart.

Medical Errors Result in Nearly 250,000 Deaths from 2004-2006 Errors Cost Medicare Program $8.8 Billion Over Same Period Centers for Medicare and Medicaid Services

Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths from 2004 through 2006, according to HealthGrades’ fifth annual Patient Safety in American Hospitals Study.

According to the study, the death rate for golfers is 40 percent lower than for other people of the same sex, age, and socioeconomic status. This corresponds to a five-year increase in life expectancy.

HealthGrades analyzed 41 million Medicare patient records, finding 1.1 million patient safety incidents during the three years studied. Of the 270,491 deaths that occurred among patients who developed one or more patient safety incidents, 238,337 were potentially preventable.

Golfers with a low handicap have the longest life expectancy. A team of researchers from Karolinska Institutet has now presented a study of the health effects of golf, which is a lowintensity form of exercise.

The study also found that Medicare patients who experienced a patient-safety incident had a one-in-five chance of dying as a result of the incident.

The study, which is published in Scandinavian Journal of Medicine & Science in Sports, is based on data from 300,000 Swedish golfers and shows that golf has beneficial health effects.

“While many U.S. hospitals have taken extensive action to prevent medical errors, the prevalence of likely preventable patient safety incidents is taking a costly toll on our health care systems – in both lives and dollars,” said Dr. Samantha Collier, HealthGrades’ chief medical officer and the primary author of the study.

Professor Anders Ahlbom, who led the study, was not surprised with the results of the study, as he believes that there are several aspects of the game that are proved to be good for the health. “A round of golf means being outside for four or five hours, and walking at a fast pace for six to seven kilometres, something which is known to be good for the health,” he said. “People play golf into old age, and there are also positive social and psychological aspects to the game that can be of help.” The study does not rule out that factors other than golfing, such as a generally healthy lifestyle, are also behind the lower death rate observed among golfers. However, the researchers believe it is likely that playing golf in itself has a significant impact on health. Golf players have a lower death rate regardless of sex, age, and social group. The effect is greater for golfers from blue-collar professions than for those from white-collar professions. The lowest rates are found in the group of players with the lowest handicap. Maintaining a low handicap involves playing a lot, so this supports the idea that it is largely the game itself that is good for the health, said Professor Ahlbom. Source: Karolinska Institutet, www.ki.se

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Medical errors in medicare have become such an issue that as of October 1, 2008, Medicare will stop paying U.S. hospitals to correct eight preventable medical errors cause by their own negligence, including: Urinary-tract infections from catheters; bloodstream infections from catheters; falls; bedsores or pressure ulcers; objects left in surgery patients; blood incompatibility; mediastinitis; a postheart-surgery infection; and, air embolism, an air bubble in a blood vessel. Hospitals themselves will pay for the additional procedures and extended hospital stays required to fix these problems; Medicare regulations expressly forbid hospitals from shifting the costs to patients. Private insurers are expected to follow Medicare’s lead.

DCs May Still Have to File Maintenance Care with Medicare Since the release of the most recent Advance Beneficiary Notice of Noncoverage (ABN), a number of organizations and periodicals have reported that doctors of chiropractic are no longer required to bill maintenance care. THIS IS NOT TRUE! ACA has sought clarification from the Centers for Medicare and Medicaid Services (CMS) and has confirmed that, in most instances, maintenance care must still be billed. Most of the confusion on this matter lies with the new "Option 2" box that allows patients to indicate that they wish to receive the services but do not want the provider to bill Medicare. In addition to this new option, other changes include a requirement to enter an estimated cost and to verbally review the form with patients prior to them signing it.

ISCA Report

July/August 2008


Join us for the 2008 ISCA Annual Golf Outing When: Tuesday, Sept. 23 Where: Purgatory Golf Club 12160 E 216th St. Noblesville, IN 46060 • • • • •

Rain or Shine 4-person scramble format Team check-in - 10am Shotgun start - 11am Dinner & prizes - 5pm

Register online at www.indianastatechiros.org!

$105 Member /$130 Nonmember Fee covers green fees, cart, gift bag, dinner and drinks. Individual golfers welcome!

Sponsorship Opportunities Clubhouse Sponsor - $2000 (1 available) • 1 team including dinner • Banner & speaking time at dinner • Prominent position of logo on all event material • Hole sponsorship • Opportunity to have your representative at sponsored hole Golf Cart Sponsor - $2000 (1 available) • 1 team including dinner • Flag with logo on every golf cart • Prominent position of logo on all event material Lunch Sponsor - $1,000 (1 available) • Banner with logo at lunch • Opportunity to have your representative at lunch • Prominent position of logo on all event material

“The Masters” Hole in One Sponsor - $500 • Hole in One prize - a trip for two to the Masters (or your choice of other premium Hole in One prizes) • Your choice of a Closest to the Pin Prize • Signage at the sponsored hole • Presentation of award at dinner • Opportunity to have your representative at sponsored hole. Practice Green or Driving Range Sponsor - $300 • Signage at practice green or driving range • Opportunity to have your representative at practice green or driving range

Company ________________________________________________ Contact Name ___________________________________________ Company Address ________________________________________ City__________________________ St. __________ Zip _________ Phone _________________________ Fax ______________________ E-mail address: ____________________________________________ Your team: 1. ______________________________________________________ 2. ______________________________________________________ 3. ______________________________________________________ 4. ______________________________________________________ Advance Purchase Raffle/Contest Package (Limit: One per team) Buy a Raffle/Contest Package before the event and save $40. The package includes: • 2 mulligans for each member of your team • An armstretch of raffle tickets for each member of your team • 1 entry per team for the “skins game” $100 advance purchase / $140 day of the event

July/August 2008

Par 3 Sponsor - $250 • Signage at the sponsored hole • Closest to the Pin Prize (and a Hole in One prize if a hole in one occurs) • Presentation of award at dinner • Opportunity to have your representative at sponsored hole Longest Drive or Longest Putt Sponsor - $275 • Signage at the sponsored hole • Presentation of award or prize at dinner • Opportunity to have your representative at sponsored hole Hole Sponsors - $150 • Signage at the sponsored hole • Opportunity to have your representative at sponsored hole To participate as a sponsor, indicate so on the attached registration form or contact Stephanie Higgins at 317.673.4245 or e-mail shiggins@lmvconsulting.com. Golf carts available to sponsors upon request.

Quantity

Amount

Golf & Dinner Members @ $105 ea. Golf & Dinner Nonmembers @ $130 ea.

Dinner Only @ $35 ea. Raffle Package @ $100 per team 1 per team Golf Door Prize Donation: Sponsorship Type: Need a “sponsor’s” golf cart? __ yes __no Total Enclosed Payment Options __ Check Enclosed __ MasterCard __ Visa __ Amex __Discover Card No. ___________________________________________ CID No. ________ 3-digit # next to signature line on back of card Exp. Date ___________________________________________ Cardholder’s Name _________________________________ Signature:________________________________________

ISCA Report

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Bernanke: Improving health care is critical challenge By JEANNINE AVERSA | AP Economics Writer

Bolstering the performance of the U.S. health care system is one of the biggest challenges facing the country, Federal Reserve Chairman Ben Bernanke said. New medical technologies and treatments are allowing people to live healthier, longer and more productive lives. However, the aging of millions of baby boomers coupled with rapidly rising heath care costs are accounting for an ever-growing share of both personal and government budgets -- strains that will become increasingly burdensome unless changes are made, the Fed chief warned. Challenges, he said, fall into three major areas: improving access to health care for the 47 million Americans -- or about 16 percent of the population -- who lack health insurance; bolstering the quality of care; and controlling costs. "Improving the performance of our health care system is without a doubt one of the most important challenges our nation faces," Bernanke said in remarks to a summit on health care reform organized by a Senate panel on Capitol Hill. On the health care front, Bernanke didn't recommend specific solutions, saying the difficult choices involved with improving access and quality, and controlling costs were best left to policymakers in Congress, the White House and elsewhere. "Taking on these challenges will be daunting," he said. Given the complexity of health care matters, he suggested that it might be better for policymakers to consider an "eclectic approach," rather than one single set of reforms to address all concerns. "We may need to first address the problems that seem more easily managed rather than waiting for a solution that will address all problems at once," Bernanke offered. When policymakers contemplate changes, Bernanke urged them to "not lose what is good about our system." The system has

produced innovations in basic science, in the understanding and diagnosing of disease and in advancements in medical technology, he pointed out. These advances have produced more effective treatments and significant reductions in mortality across a wide spectrum of diseases, he added. Bernanke, once again, warned high health care costs will put an increasing strain on people's and government's budgets, unless those costs are curbed. Spending on health care is the single-largest component of overall consumer spending -- larger than spending on either housing or food, Bernanke said. For the federal government, spending on health care accounts for about one-quarter of total spending. By 2050, it will account for almost one half, Bernanke said. "Per capita health care spending in the United States has increased at a faster rate than per capita income for a number of decades," he said. "Should that trend continue, as many economists predict it will, the share of income devoted to paying for health care will rise relentlessly," Bernanke predicted. That will make health insurance and out-of-pocket payments increasingly unaffordable, he said. However, if the government doesn't rein in the growth of entitlement programs, such as Medicare and Social Security, those exploding costs in time will balloon the U.S. budget deficit, which would hurt the country's long-term economic vitality and could lead to higher interest rates, Bernanke said. "Certainly, it will have effects on interest rates, it will have effects on economic growth and on stability," he said. The government, he said, needs to move ahead sooner, rather than later, because these issues "are not going to get better" and instead will only "get worse."

Don't Forget: Medicare Providers Must Use ONLY NPI Numbers on Claims Effective May 23, 2008, all Medicare providers are required to use ONLY their NPI number when filing Medicare claims. The reporting of Medicare legacy numbers will result in claim denial. If your CMS-1500 claims are rejected, visit the National Plan and Provider Enumerator System (NPPES) Web site to make sure all the information for your NPI is accurate. If claims continue to be rejected, have a copy of your NPPES record in hand (available on the NPPES Web site) and contact your Medicare contractor. For more information, see the NPI portion of the ACA Web site at or visit the CMS Web site.

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ISCA Report

July/August 2008


What it Means to ‘Keep Inviolate’: Your Patients deserve to have their health information protected and respected at all times. Stephen M. Perle, DC, MS

“Doctors of chiropractic should preserve and protect the patient’s confidential information, except as the patient directs or consents, or the law requires otherwise.” – Tenet IV, ACA Code of Ethics

psychology offices take doctor-patient confidentiality so seriously that they have an unmarked exit door that is separate from the entrance to the practice.

The oath we took during commencement exercises include the line, “ I will keep inviolate all things revealed to me as a physician.” This is a fancy way of saying you will not tell anyone what patients tell you.

No one expects that doctors of chiropractic will have a separate entrance and exit, but there are many chiropractors with “open” offices. Obviously, some patients are not concerned with the lack of privacy in an open floor plan; however, there are individuals who will not visit, or return to, an office where the floor plan says the doctor does not respect the patient’s privacy. Meanwhile, other patients may just be quietly uncomfortable in such a setting.

Patient autonomy, the right to control what happens to our own bodies, is a fundamental right. It includes the right to privacy with respect to our information about our bodies and our health. Maintaining patient confidence is critical so that patients will share all the information required by their doctors to make appropriate clinical decisions. HIPAA has codified patient privacy into law, but where does the ethical standard go above what the law requires? Sign-in sheets, for example, are legal under HIPAA, especially if you make certain efforts to limit the exposure of protected health information (PHI). You could limit exposure to PHI by asking only for patients’ names and time of arrival, or by marking through their names periodically during the day. However, just because something is legal does not necessarily mean that it is moral. Doctor-patient confidentiality should extend beyond a sign-in sheet to the mere fact that a person chooses to call upon a certain doctor for his healthcare needs. One of the most extreme levels of doctor-patient confidentiality is witnessed in the mental health community, where some patients fear negative consequences if the mere fact of their treatment by a psychiatrist or psychologist is revealed. Even on the TV show, “The Sopranos,” the character Tony Soprano noted the potential harm to his status as a feared mob boss if the fact of his therapy sessions with Dr. Jennifer Melfi were revealed. Some real world psychiatry/

Likewise, an office with a bulletin board listing those who have referred new patients or that announces patients’ birthdays and anniversaries can also be viewed as a sign proclaiming: “Doctorpatient confidentiality is not practiced here!” Talking with one patient about another patient breeds further distrust. A patient can rightly ask, “If the doctor will talk about my friend’s condition to me, who says he won’t talk about me to someone else?” Moreover, it’s not uncommon to hear a doctor talk about one of his celebrity patients as if the celebrity’s head was mounted like a trophy on his wall. I understand how having a famous patient can make a doctor feel validated; however, a doctor shouldn’t violate a patient’s trust to pump up his own ego or business. Keep in mind that concepts of privacy have changed over the years. For example, even though the press corps was aware that President Franklin Roosevelt was paralyzed, the public at large never knew because it was not reported. Nowadays, teams often report athletes’ health information, which gives the impression that they don’t deserve privacy, yet celebrities and athletes are just as deserving of privacy protection as the humble and the anonymous. We must always remember to preserve the privacy of our patients’ information – including the mere fact that we are their doctors. Upcoming ISCA Events Mark your calendars, ISCA has many great events coming up this year - you won't want to miss out! Check out www.indianastatechiros.org for updates!

ISCA GOLF OUTING September 23, 2008 Purgatory Golf Course 12160 E. 216th S. Noblesville, Indiana 46060 2007 US Track and Field National Championships In the photo are ISCA Sports Committee Members: Dr. Gary Shaw and Dr. Sheila Wilson. Dr. Curtis Harris (not pictured) was also part of the 2007 Medical Team. All three committee members have been chosen to treat our US Olympic Track and Field hopefuls and the 2008 Olympic Trials for Track and Field in Eugene Oregon.

July/August 2008

ISCA Report

ISCA FALL CONFERENCE October 31 - November 2, 2008 Sheraton North, Indianapolis 8787 Keystone Crossing Indianapolis, Indiana 46240

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What does OIG investigate? Dr. Marty Kotlar, DC, CHCC, CBCS

Q – I understand the Office of Inspector General (OIG) investigates healthcare providers who bill and code incorrectly. Can you give me a few examples of what would cause a “red flag: to the OIG and why the OIG performs these types of investigations? A – One reason why the OIG performs these investigations is because of the amount of money it recoups. In 2006, the federal government won or negotiated approximately $2.2 billion in judgments and settlements in healthcare fraud cases. The Medicare Trust Fund received approximately $1.5 billion as a result of investigative efforts in addition to the $177.1 million in federal Medicaid money similarly transferred separately to the Treasury Department as a result of these efforts. The Health Care Fraud and Abuse Control Program (HCFAC) account has returned more than $10.4 billion to the Medicare Trust Fund since the inception of the program in 1997. The OIG does not pursue action against healthcare providers who merely make innocent billing and coding mistakes. Individual carriers, Centers for Medicare and Medicaid Services (CMS), and their contractors address these types of claim errors and mistakes. However, certain billing and coding issues attract attention and have caused numerous healthcare providers to get in trouble. Here are some chiropractic and non-chiropractic examples: • Fraudulent Billing. A former chiropractor arranged presentations at senior citizen centers and other locations where he distributed back braces valued at less than $100 each. He then billed government or private health insurers $1,300 for each brace. He was sentenced to 12 years and 6 months in prison, and ordered to pay $1.5 million in restitution for billing Medicare, Medicaid, and private insurers for medically unnecessary back braces. •

Preprinted prescriptions and CMNs. Over a two period beginning in 2002, a Houston osteopath signed preprinted prescriptions and certificates of medical necessity (CMNs) for motorized wheelchairs in exchange for payments from marketers of durable medical equipment (DMEs).

He rarely examined the Medicare and Medicaid beneficiaries in whose names the prescriptions and CMNs were prepared. The marketers, in turn, sold the signed documents to DME suppliers in Texas and elsewhere. A jury convicted him on 13 counts related to healthcare fraud. He was sentenced to 10 years in prison and ordered to pay $7.9 million in restitution to Medicare and Medicaid. The osteopath’s fraudulent activity has been linked to nearly $8 million in Medicare and Medicaid payments. •

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Undelivered products. In Tennessee, an individual was sentenced to 23 months in prison and ordered to pay $1.8

million in restitution for his role in a scheme to defraud Medicare. As the self-described “ring leader,” the defendant recruited friends and family members to establish DME suppliers with different names. These suppliers billed Medicare for enteral nutrition products that were never provided to any beneficiaries. In some instances, the suppliers provided only flavored milk products to the elderly, but billed Medicare as if the companies were providing enteral nutrition. •

Switched products. In Texas, the owner of a DME supplier plead guilty and was sentenced to 63 months in prison for the fraudulent billing of expensive motorized wheelchairs and other DME.

The owner paid recruiters to collect Medicare and Medicaid beneficiary numbers and other information in Texas and in surrounding states. The owner then used the patient information to bill Medicare or Medicaid for DME, while providing less expensive products to the named beneficiaries, or none at all. Through this scheme, the owner was paid $1.6 million by Medicare and Medicaid. In addition to the prison sentence, the owner was ordered to pay $669,000 in restitution. •Ambulance services. In North Carolina, an ambulance company owner instructed emergency medical technicians to enter information on ambulance reports that falsely indicated that patients required transportation by ambulance when, in fact, they could have been transported by other means. To conceal this activity, the owner and the billing manager altered records to indicate medical necessity. They were convicted of billing Medicare and Medicaid for dialysis patient transports that were not medically necessary. The owner was sentenced to 120 months in jail for healthcare fraud and to an additional 31 months in jail for obstruction. The company and the owner were also ordered to pay $604, 000 in joint-and-several restitution. The billing manager was previously sentenced and was ordered to pay $30,000, a portion of the jointand-several restitution amount • Billing under false names. An Ohio podiatrist defaulted on federal student loans. This cause Medicare to exclude him in 2000 and prohibited him from billing Medicare for podiatry services. Despite this, he continued to bill Medicare under a corporate name, which happened to be the names of former podiatry school classmates, including one who was, at the time, dying of cancer. None of the former classmates gave the podiatrist permission to use their names. In 2002, he persuaded the government to lift the exclusion, and began billing Medicare for complex procedures

ISCA Report

July/August 2008


What does OIG investigate? Continued... – but only routine nail-trimming services were provided. He was sentenced to 78 months in prison for conspiring and scheming to defraud Medicare. In addition to prison time, he was ordered to pay $528,000 in restitution. •

Unnecessary narcotic injections. A pain-management physician would administer, to all his patients, unnecessary and painful “trigger-point” injections of Schedule II and III narcotics. Once addicted, his patients would return for weekly injections, and were often forced to contribute to a “malpractice insurance fund.”

In two instances, the injections led to fatal drug overdoses. The physician submitted $60 million in fraudulent bills to healthcare benefit programs, claiming he was performing multiple complex epidural and nerve block injections when, in fact, he performed crude versions of lower cost trigger-point injections. He was sentenced to life in prison, plus an additional 20 years, for two charges of healthcare fraud resulting in death in addition to other charges of healthcare fraud.

procedures that were not medically necessary on patients and billed for services not performed or not performed as indicated. The dentist was found guilty in a jury trial on charges of mail fraud and healthcare fraud, and was sentenced to 63 months in prison and ordered to pay $827,000 in restitution and a $20,000 fine. •

Billing without a license to dispense. A California audiologist was sentenced to 178 months in prison for defrauding Medicare and Medi-Cal. From January 1997 through July 2003, the audiologist billed Medicare and Medi-Cal for hearing aids, speech therapy, and other related services without being licensed to dispense or render the service and, in most cases, without a prescription from a referring physician. The audiologist also billed for services purportedly provided to deceased beneficiaries. In addition to the prison sentence, the audiologist was ordered to pay $868,000 in restitution.

In addition to the prison sentence, he was ordered to pay $14.3 million in restitution to Medicare and Medicaid. •

Unnecessary dental procedures. An Illinois dentist performed

Report Says Antioxidants Do Not Prevent Mortality From: Chiropractic Economics Issue 9 June 11th

A report published in the Cochrane Database of Systematic Reviews (April 16, 2008) concludes that antioxidant supplements have little effect on mortality. Researchers looked at 67 randomized trials with 232,550 participants. The aim of the research was to assess the effect of antioxidants on mortality in primary or secondary prevention randomized trials. The scientists included all primary and secondary prevention randomized clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus either healthy (primary prevention trials) or had any disease (secondary prevention trials). Researchers concluded that the antioxidant supplements had no significant effect on mortality in a random-effects meta-analysis, but significantly increased mortality in a fixed-effect model. In the trials with a low-risk of bias, the antioxidant supplements significantly increased mortality. When the different antioxidants were assessed separately, analyses including trials with a low risk of bias and excluding selenium trials found significantly increased mortality by vitamin A, beta-carotene, and vitamin E, but no significant detrimental effect on vitamin C. Low-bias risk trials on selenium found no significant effect on mortality. The researchers concluded there was no evidence to support antioxidant supplements for primary or secondary prevention. They said the current evidence does not support the use of antioxidant supplements in the general population or in patients with certain diseases. The combined evidence suggests that additional research on antioxidant supplements is needed. The review did not assess antioxidant supplements for treatment of specific diseases (tertiary prevention), antioxidant supplements for patients with demonstrated specific needs of antioxidants, or the effects of antioxidants contained in fruits or vegetables. Further research and systematic reviews on these types of interventions are therefore warranted. Source: G Bjelakovic, D Nikolova, LL Gluud, RG Simonetti, C Gluud, “Antioxidant supplements for prevention of mortality in healthy participants and patients with various disease,” Cochrane Database of Systematic Reviews (April 16, 2008)

July/August 2008

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2008 Fall Conference October 31 - November 2

Sheraton Hotel 8787 Keystone Crossing Indianapolis

Don't miss the Isca fall seminar Please join us for an outstanding line up of speakers and topics for our Fall Conference, October 31 - November 2 at the Sheraton Indianapolis Hotel located at 8787 Keystone Crossing. We welcome Dr. Warren Hammer as our key speaker on Friday evening and on Saturday. Dr. Hammer is the author of Functional Soft Tissue Examination and Treatment by Manual Methods, 3rd Edition, in addition to many published articles and is a nationally and internationally renowned lecturer. The Indiana Spine Group will be presenting the following lectures on Saturday in addition to a Sunday session of case studies in which attendees can bring in their own cases for discussion. • • • •

Minimally Invasive Spine Techniques (Kevin Macadaeg, MD) The Surgical Candidate (Thomas Reilly, MD) The ABCs of Lumbar Surgery (Kenneth Renkens, MD) The ABCs of Cervical Surgery (Rick Sasso, MD)

Case Studies Minimally Invasive Diagnostic and Therapeutic Techniques (Jonathan Gentile, MD and John Arbuckle, MD) Imaging Pearls (Thomas Reilly, MD, and Paul Kraemer, MD) The Surgical Patient (Thomas Reilly, MD, and Paul Kraemer, MD) In addition to this power packed line-up, we are offering risk management hours (Friday and Sunday). CA Bootcamp: Doctors, Don't let your CAs miss out on this great program Sam Martin with ChiroComplete has partnered with ISCA to put together a Saturday CA Bootcamp focusing on different areas of what CAs do in the office to help the Doctor they work for. More details are forthcoming. Call for Nominations The 2008 Fall Conference is also the time for ISCA's Annual Meeting. Nominations will be accepted to fill expiring positions on ISCAs Board of Directors. ISCA's Board of Directors positions include: At Large Directors (elected from any part of the state), District Directors (specific to each Congressional/ISCA Membership district), Alternate Directors (both District Level and At Large). If you are interested in filling one of these roles, or are interested in nominating yourself to fill a committee position, please contact: Lane Velayo Indiana State Chiropractic Association Association Manager lvelayo@lmvconsulting.com 317-673-4245

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Register online at www.indianastatechiros.org!

ISCA Report

July/August 2008


Registration Form

Registration Type Platinum.......... complimentary Gold & Silver............................... Member (in good standing)..... Member (in arrears)................... Non-Member..............................

Register online at www.indianastatechiros.org!

Package A 12 Hour Session

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After Adv. Mar. 2

Package D: CA $89 Package E: Guest (non DC) $75 Package F: Student $75 Package G: Lunch Ticket $30

CONTACT INFORMATION Confirmations will be mailed to this address. Clinic Name

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Questions? Call 1.317.673.4245, or e-mail info@indianastatechiros.org / Refunds at 90% until October 17. No refunds after October 17.

July/August 2008

ISCA Report

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Indiana State chiropractic association classifieds PRACTICES FOR SALE Progressive college community close to Fort Wayne, Indiana. Busy highway. Long-established beautiful chiropractic office with space to expand, sublet, and/or live in. Creative financing for doctor ready to own practice. Phone 260-402-7657 or email: buyyourpractice@hotmail.com Central Indiana Chiropractic practice for sale. Well established (29+ years) in a large, free standing building that boasts low overhead, ample parking space, visible signage, and high patient traffic. This practice has consistent collections in over $240,000 per year with a minimum of 400 to 500 a month. General diversified practice, fully equipped. Excellent opportunity. Practice has great growth potential. Serious inquiries only, please. Contact Seller at 765-398-2179. Posted 4/29/08 Office suite for lease in historic downtown Noblesville. Great opportunity for a chiropractor to have an office ready to go. Call 317-774-1010. Posted 3/20/08 Retiring in progressive south central Indiana town. Turnkey opportunity in fully equipped fully staffed newly remodeled office. Serious inquiries only, please. Confidentiality agreement must be signed before any information is shared, but priced for quick sale. Send email to dcprac4sale@hotmail.com Posted 3/5/08 Practice for sale in Lawrenceburg, Indiana. 10 year old well-established practice in a rapidly growing area. $250,000 gross in 2007 on 3 days per week. General diversified practice, fully equipped, modalities, low-tech rehab, x-ray. Excellent oppurtinity. Practice has great growth potential. Motivated seller. Contact Dr. Mike at 513-266-6261. Posted 2/8/08 Associate to Owner Opportunity in 1 year Indianapolis, IN Energetic, Enthusiastic Chiropractor wanted for fabulous associateship to owner opportunity in Indianapolis. Work to learn the practice in 2008 and own the practice in 2009. This Indianapolis office which has been established for 40+ years. This practice has over 8500 patient files and has collections consistently over $250,000 with $150,000 cash flow to the doctor. Great patients. Great practice. Great opportunity to learn earn and own an established practice. Only financially secure persons need respond to indianapolisopportunity@gmail.com Posted 2/6/08 Building Only -- Ft. Wayne: Free Standing High Traffic St. Ample parking, signage, close to downtown area. X-ray machine/Processor included. New roof and re-entry remodeled. Business about 1,100 SF plus 2 bedroom

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apartment attached with appliances. Great place to start or relocate. Priced to sell: $139,500 OBO Call 260-433-0514. Posted 1/21/08

Associates Available Recent male graduate. Proficient in many techniques, including Cox and McKenzie. I am punctual, hard working and willing to learn. Looking for a fulltime associate position in the Indianapolis metro area. For more information please contact Chris via email at yoshi01@gmail.com. Posted 5/7/08 Palmer graduate. 25 years experience, excellent adjusting and people skills. Multiple techniques including Activator and Cox. References available. Call Dr. Grotzinger 317.585.4808. Posted 3/17/08 Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/ Vac fill-in. Available for temp.or permanent work. For more information please contact 765683-0845 or katsan7@yahoo.com Kathleen Sanderford, D.C. Posted 2/14/08

Associates Wanted Busy MD/DC/PT practice need Associate Chiropractor. Option to buy after one year. 50K + incentive for first year. Further details upon request by email. drbenc@msn.com Posted 6/17/08 Associate Wanted Active Chiropractic & Rehabilitation Clinic Evansville, Indiana www. evansvillechiro.com Must be open to rehabilitation and Active Release Therapy and a licensed DC in Indiana with excellent patient communication, service and technical skills. Send confidential resume to barbiealbrown@yahoo.com. Posted 5/19/08 Doctor needed for new office in NW area. Don't miss this opportunity! Must be willing to make great money and work as your own boss. Start immediately. Fax resume to (219)987-3366 or Email it to jdbovay@aol.com Posted 5/14/08 New state of the art clinic in Fishers, IN. Dr. would like to relocate out of state. Either share space or take over entire clinic. Great opportunity to have an office ready to go! Equipment includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. Staff includes a Massage Therapist. Currently 2,000 sf with potential of 5,000 sf along with % of property ownership. Call (317) 607-0464 if interested in learning more.

ISCA Report

Having Trouble Getting Started? No Need to Sign Your Life Away! New state of the art clinic located in beautiful Fishers, Indiana. Visit www.fishersfind. com to learn more about fantastic demographics. Share space or take over entire clinic. Great opportunity - turn key office ready to go! Equipment includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. you name it! Staff includes a Massage Therapist. Provider insurance benefits pay well. Set your own hours and share the walk-ins! Start your practice for only $3,950. Call (317) 607-0464 or email backworks@ comcast.net if interested in learning more. Posted 5/7/08 Chiropractic Associate Needed Rapidly expanding Practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic, ambitious doctor is a must. Must be proficient in Cox Technique, Palmer Diversified Technique and Thompson Technique. Salary and profit share of clinic are offered. Send Resume to Dr. Danielle Kauffman 7620 E. 109th Ave, Crown Point, IN 46307 or E-mail to chirodan@comcast.net. Posted 4/30/08 Busy Chiropractic office looking for tandem chiropractor. Must use Thompson, Activator, Cox Flexion/Distraction. Pay starts at $1000/wk. Bonus pay with practice growth. Trimboli Chiropractic is in Indiana 35 minutes from Downtown Chicago. Contact us at: info@trimbolichiro.net, by phone (219)836-8890 or by fax (219) 836-2344. Posted 4/30/08 Central Indiana Practice seeks hard working, well skilled, caring, dedicated Chiropractor proficient in various techniques. Serious candidates only. Contact 765-398-2179 for further details. Posted 4/29/08 Busy Southern Indiana practice looking for an intelligent, ethical chiropractor with excellent adjusting skills-diversified/Gonstead. Experience is a plus. 28-30 hrs/week. Please fax your resume to 812-275-8044 or email to thcc4@comcast.net Posted 4/15/08 Rapidly expanding Practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic, ambitious doctor is a must. Must be proficient in Cox Technique, Palmer Diversified Technique and Thompson Technique. Salary and profit share of clinic are offered. Send Resume to Dr. Danielle Kauffman 7620 E. 109th Ave, Crown Point, IN 46307 or email chirodan@comcast.net. Posted 4/7/08 Great Opportunity for an Independent Contractor in a fast growing, hard working practice on the northside of Indianapolis. Please call (317-7761061) or fax resume (317-776-1172). Posted 3/20/08

July/August 2008


Indiana State chiropractic association classifieds Chiropractic Coverage Needed Maternity coverage need in Crete, Illinois (40 min. south of Chicago) starting June 2008 for 6-8 weeks. Must be proficient in Thompson, Diversified, Cox techniques and base knowledge of Activator is a plus. Send Resume to Dr. Sara Wallace 1020 E. Steger Road Crete, Il 60417 or E-mail to drsarawallace@yahoo. com. Posted 3/10/08 $50-75K Starting Base Salary + Bonus: South Bend IN Doctors needed for practices in the South Bend, Indiana region. Our rapidly expanding practices incorporate the services of Chiropractic, Massage, Physical therapy, Acupuncture, and Nutrition. Our practice concept is unique, with a heavy emphasis on patient customer service, achieved by a thorough training program for doctors and staff. Our doctors do not participate in spinal screeningtype marketing; we network with the local medical community. Doctors enjoy good growth potential, advancement opportunities, CEU's, Malpractice Insurance, medical and dental benefits, and profit sharing program. Doctors must be eligible to work in the United States and possess a valid driver's license. Preventive Medicine doctors are expected to grow their clinics. $1000 Signing Bonus. Send resume to: Carrie Hannon c/o Preventive Medicine, PC 212 W. Edison Rd, Ste B Mishawaka, IN 46545. ph: 866-499-1400 ext 201 fax: 574254-1650 email: hr@preventivemedicinepc.com www.preventivemedicinepc.com Posted 2/29/08 Christian doctor seeking Tandem Associate for busy, growing 15 year-old Hendricks County practice to help care for this rapidly growing community. Current doctor and father of 6 looking for intelligent, ethical, personable doctors who are still willing to learn, commit to long-term working relationship. Potential candidates require a passion for excellence and a burden for caring for people. Serious inquiries only. Send resume to docrocbyrd@sbcglobal.net Posted 2/25/08 Busy chiropractic office in NW Indiana looking for an associate to begin as soon as possible. Please fax your resume to (219) 736-7363 or email to rhkchiro@sbcglobal.net Posted 2/13/08 Wanted! Chiropractic Neurologist / Board Certified or Eligible to join with established Chiropractic Neurologist in Indy Metro area. Please send resume to drspine26@yahoo.com Posted 2/11/08 Looking for an associate. New dr or just sick of running your own practice? We can help! Salary + bonus. 28 hour work week. No Fridays or Saturdays. Not a misprint! Give me a call! Terry Tolle 317-496-2530 Posted 1/24/2008

July/August 2008

Established Indianapolis chiropractor looking for associate interested in joining a multi-disciplinary practice. AO experience a plus. Check us out on the web at www.PratherWellness.com. Send resume and cover letter to info@pratherwellness.com. Do you want to be a Dr. or a back cracker? Learn from a Dr. trained in orthopedics, AK, and functional medicine. Treat more than just sore backs. Call Peter H. Dyer D.C. 574-583-7012

Vacation Doctors Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/ Vac fill-in. Available for temp.or permanent work. For more information please contact 765683-0845 or katsan7@yahoo.com Kathleen Sanderford, D.C. Posted 2/14/08

Equipment For Sale Transworld 325 MP X-Ray Machine, great condition. Protec Optimax processor, like new. Film box, dark room light, 7 film cassettes. Total Price: $5,000. Contact Sheila at 317-258-8670. Posted 6/18/09 Waiting Room Furniture for Sale: 6 piece set: 4 chairs with arms, 1 love seat, 1 couch; maple wood and grey cloth upholstery. 5 years old, excellent condition. Total Price: $500. Contact Sheila at 317-258-8670 Posted 6/19/08 Hands Free Ultra Sound, Bowflex Machine, Health Star Elite Decompression Table, Computerized Range of Motion and Manual Muscle Test Functional Outcome Assessment Machine. Call SpinalAid at 317-272-4100. Posted 6/09/08

processor and processor stand & Processor Chemical storage containers Id flasher x-ray bin floor model Calipers 1 double bank view box 2 single bank view boxes 8 - 8x10 x-ray cassettes 4 - 14x17 x-ray casstettes Also available: Metal Xray storage rack $750.00 For offers contact us at 1-765-914-8943 or 812-858-1008. E-mail us at drjohn@newburghchiro.com Posted 4/1/08 ZENITH 95 Flexion Distraction table. Pancake elevation switch. Barely used burgundy cushions. No scratches, tears, or mechanical issues whatsoever. Great table in great shape. $4000 ($8395 new). GALAXY stationary adjusting table with armrests, face slot and paper attachment. Brown/tan color. Very good shape. $100. Call 765935-1000. I have pics of both tables. Posted 3/26/08 Entire chiropractic office of equipment available; 3 years old; all in excellent shape; X-ray machine, office desk, chairs, stationary tables, 1 poweractivated table, exercise equipment. Office suite for lease in historic downtown Noblesville. Great opportunity for a chiropractor to have an office ready to go. Call 317-774-1010. Posted 3/20/08 FLEXION DISTRACTION TABLE-manual table made by Barnes. Good shape, burgundy upholstery, extra ankle straps. $1000 or best offer, Call Dr John 299-3330 or drvolbers@comcast.net Posted 2/19/08

Post a Classified Ad

ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. Non-members may place ads for $25 per ad per issue. To place a classified ad visit us online at www.indianastatechiros.org or call 317.673.4245.

TerraQuant Laser MQ2000 All-in-One Cold Laser: Only 1 year new - like brand new! $2,950.00 obo Chattanooga Decompression Table CDTU4: Purchased one year ago and rarely used. Combines TX Head with an Elevation table, Cervical, Carpal Tunnel Traction & Spinal Decompression, Complete with: 4 piece elevation table, hand control, tilt head & tilt back rest, casters, Saunder Cervical Traction device, CarpalTrac, Split Knee Bolsters & Exclusive EZ-grip Thoracic & Lumbar belting System. Electric Hi-Lo adjustment from 21" to 41". Full 27"x77" working surface. $7,500.00 obo. Phone: 317-9159800 Email: backworks@comcast.net Posted 5/14/08 Equipment for sale in southwestern Indiana Barely used, great condition, only 4years old Complete Xray package Includes all of the following for only $ 13,000 DTR High Frequency X-ray unit - generator, bucky stand, cathode and board Mini Med AFP

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ISCA Report

200 S. Meridian St. Suite 350 Indianapolis, IN 46225 317.673.4245 www.IndianaStateChiros.org

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ISCA Jul/Aug Newsletter 2008