THIS POST SHOULD BE READ CAREFULLY BY ALL LIST MEMBERS INVOLVED IN PERSONAL INJURY - WORKERS COMPENSATION AND INSURANCE BILLING PRACTICES....
Illegal referrals or Postal Fraud? That is the question.
In the Whitter Daily News, November 27, 1996 the headline reads, "Sentence
Given in IRS Case - Chiropractor gets 21 months in Prison.
The case involves Chiropractor Chongsu Kim of San Marino California who
plead guilty to paying illegal kickbacks to attorneys in a ONE YEAR STING
operation wherein an undercover Federal agent was planted in his office
acting as "office administrator", and was given money to pay kickbacks to
lawyers for referral. As a result of the investigation, Kim was also
charged with concealing 1.6 million in income from the Internal Revenue Service.
Kim's wife, is also charged and pending sentencing May 5, 1997.
The new story goes on to say that:
"About a dozen more doctors, lawyers and administrators are expected to be
charged in connection with the case."
READ BETWEEN THE LINES. Ask yourself the following question: Why is Kim
only doing 21 months for this leve lof criminal activity? Did he plea
bargain to give up his co-conspirators? Was he naive, listening to the
advise of attorneys who may have told him this was all OK? Is he a criminal
or just foolish?
Due to the recent publication of the fraud accusations against former ICA
president Dr. Gregg and others relating to procurement and referral for
diagnostic services, there is a need to inform the chiropractic community
about such operations. Many, MANY D.C.'s who are pure minded and honest
hard working clinicians could be involved in similar operations without a
clue that they are under investigation.
The following case from my personal file is of great significance in this
regard. A few years ago, I was the Academic Dean of Physicians Academy in
Dallas, Texas. Physicians Academy is a one year postgraduate course of
study in advanced clinical concepts and diagnostics.
I received a telephone call from a chiropractor who had three clinics.
High personal injury volume, very successful and a great treating doctor.
The reason that he enrolled at Physicians Academy was his desire to learn
more about objective evidence to validate his patients need for care.
He bought all the diagnostic devices available. Thermography, digitizing,
SEMG, Dynatron Muscle testing etc. He took an additional step however, one
I thought unique. He also hired representative doctors from each of these
companies to come and personally train his doctors and staff on each of the
pieces of equipment.
He told the staff doctors at these workshops, that it was their own
discretion to use the equipment as they best saw benefit to their patients
and that the manufacturers "REPS" were there to insure that the medical
necessity and outcome of the procedures were matched correctly to the
individual patient, and that the procedures were performed and interpreted
correctly.
I was duly impressed.
At Physicians Academy, a nightly round table was held for new and
established academy members. I participated in literally dozens of these
round table meetings. The purpose of theses discussions were for doctors to
meet, discuss problems and collectively come up with solutions in a wide
variety of clinical and administrative and legal dilemnas. Ethics and
advancement of chiropractic were paramount to such discussions.
At these meeting, I heard the doctor time and time again, discuss how he
had implemented these procedures, trained his doctors and how he was now
"beating" the unfair IME reviewers who worked for the insurance companies.
His passion for this was not based on his ability to increase his income
(obviously he did however), but clearly he was angered by outside insurance
biased doctors, denyng his patients access to needed care, and now he felt
he had the clinical tools to "prove" such need for treatment and to
demonstrate outcome of treatment.
Now, the phone call. He was under a disciplinary complaint for unnecessary
usage and overutilization of diagnostic tests. Physicians Academy had
recommended that I as the Academic Dean, provide testimony to the board on
these outcome assessment based devices. I agreed.
I knew trouble was brewing when I arrived and learned that the board had
been "interviewing" the doctors junior staff and that they had apparenty
ignored the hundreds of pages of documentation the doctor had provided on
his procedures. An article in the nespaper also caught my attention, an
article concerning the tremendously high "insurance premiums" being charged
to policy holders due to automobile accidents, and the need for tort reform.
The disciplinary hearing was a kangaroo court if I ever saw one. The board
protested to my giving testimony on the "diagnostic procedures" because I
was not licensed in that state. (?) The arguments made by the board about
the procedures demonstrated a factual lack of basis, and indeed ignorance.
Finally, I was allowed to give testimony following the steadfast demands of
the doctors attorney and indeed the boards attorney who recommended that
they should consider the testimony of an expert who was also involved in the
teaching and application of the very procedures the doctor was accused of
overutilizing. I gave my tetimony, answered all the boards questions, and
the hearing was over.
An interesting comment was made by the boards attorney on adjourning the
hearing. What we seem to be dealing with here is an old school board
confronted with new and developing technologies. I recommend prior to any
futher actions being taken on this doctors license, that due consideration
be given to the testimony presented to the board. (paraphrased).
Once outside, the doctor proclaimed, "We beat them. It's over, Lets eat!"
I couldn't help but blurt out, "If you think this thing is over you got a
big shock in store for you." I went on, "You are under an investigation,
a microscope. You'd better pray that your office is Squeeky Clean. I
helped you out with the basis of the procedures, and we proved our point to
be sure, but this thing is not over. There is a bigger picture here. This
state is under pressure to reform the tort system. Your board is under
pressure. You are the highest profile doctor in this state and your sir,
are a target."
He blew me off and we had a quiet and somewhat tense dinner. The next
morning he asked me if I would mind staying an extra day and review some of
his office records. Especially the records of the "green" DC's in his
clinic. As this was part of my consulting practice, I agreed.
How many do you want me to pull? he asked. Ten from each of the four
doctors, I responded. I'll have them ready for you when you get here, he
said. He was clearly apprehensive but he knew instinctually that my harsh
tone the night before was born of genuine concern.
Holy Molly-What a mess. To put it briefly, the records were virtually
identical, blueprint and inadequate. About the only thing in the records
that were accurate and reliable were the test results. I told him that I
needed to come back and do some training in records keeping and office
procedures, he and his administrator (also his wife-also later charged with
him) agreed. This was the one area in which they had slipped.
On my return visit, I was at the airport with a warm hug and a big
breakfast. I was handed a newspaper, "Hey Bill, look at this, what a
joke" he said. Well, needless to say, the article was once again about the
scam personal injury industry and the participation of doctors, lawyers,
ambulance drivers and tow truck operators. The poor citizenry of the state
were being milked out of millions. The only corporation, agency or
individual named in this article, you guessed it the Chiropractor.
"This is no (expletive deleted) Joke", I told him. You are in big trouble
here and you better wipe that (expletive deleted again) grin off your face
and call your (expletive deleted one more time) attorney,
Again he blew it off, minimizing his reality to the exposure. Well, when we
got to the office, a popular magazine was handed to me by a concerned
staffer. The article had a full page picture of a fat, red faced, evil
grinning, cigar smoking male. The title of the article "Wham Bam the
Insurance Scam"
Again, this doctor was the only individual or corporation mentioned.
Further, the board had come out with a new policy statement on high tech
diagnostics, basically they were in the opinion of the board, not medically
indicated. The claim was that all of this objective technology was too
costly and provided data that your fingers and yours eyes already new.
Objections were raised by numerous chiropractors that this was never an
official board position, but one promulgated solely by the chairman of the
board, a major IME reviewer for an insurance company that "our doctor" had
successfully sued for non payement to the tune of some $600,000. No proof
of this allegation was to the best of my knowledge ever provided.
An emergency meeting "seminar" was scheduled with the clinical staff. The
doctor in question could not attend, so the meeting was taped for his
benefit and review. Patients were cancelled, doors were closed and the
meeting began. The wife\administrator began the meeting with a statement as
to the recent inquiries with the board and the need for frankness and brutal
honesty right NOW! Dr. Cockburn she said, is nationally known for his
ethics and his techniques. We need him and we need for you to be totally up
front with us about any concerns you may have.
Well, the next three to four hours was a veritable blood bath of mis
conceptions, mis communications and primordial fear on the part of these
young clinicians. They freely voiced concerns about the way they were
practicing, the way they had been interviewed, the doubts they had about
chiropractic methods. The bad press. The comments by their patients.
When errors in their records keeping were pointed out to them, they skirted
the issue and said thats the way we were trained to do it in school. I
remember asking them, It is a state law that you take blood pressures on all
your patients. In the records I reviewed not one of you has ever done a BP.
Is that how you were trained in school? One of the green doctors said, gee
I guess not and the doctor even provides us with stethoscopes and stuff !
I went ballistic. "It is your job as clinicians to do what is best for the
patient regardless of the administration of this office, the board or anyone
else, I told them. You have to do what is right. If you don't understand a
procedure or disagre with its utilization you need to raise objections, ask
questions and get clear on what it is you are doing. It is your license
that may be in peril otherwise, not the license of this clinician you should
be concerned with. If you don't do this, then get out of this office and
get out of the profession, I said. How can you possibly pretend to work and
support a clinic that is one of the most advanced in the counrty and then
claim that you don't agree with virtually all of the clinics policies? Are
you just here for a pay check?
The administerator and her assistant were in shock. I told them later, the
microscope is being finely tuned. Someone has gotten to these kids and they
are scared to death.
I believe that the tapes of this session were eventually a god send in
reducing many of the charges in the case, in keeping the wife out of prison
and pointing towards the bigger issue. I received a subpoena delivered by
an FBI agent to testify for the prosecution. Quite an interesting
experience, let me tell you. Once the tapes became known, I was suddenly
dropped from the witness list. Curious?
Getting the big picture yet?
Ultimately. after about two years, the doctor plea-bargained in the federal
courts and is now doing time in federal prison. The offer was for 15
months. His wife did not serve time, his ultimate objective.
Were the cards stacked? Was he guilty of a crime? Was he lead down the
primrose path by ruthless personal injury attorneys? Was the board corrupt?
Should he have not sued the insurance company for these diagnostic procedure
no pays? Should he have listened more carefully to his inner - self?
Should he have paid closer attention to his "greens"? Did he just get fat
and sloppy?
I do not know. We may never know. One thing is for sure, this man is one
of my best friends. He became my friend by fighting through this ordeal
together. I know his beliefs. I know his intention. There is a lot in
this case against him that smells of very foul play.
Regardless, he is in jail. That is the truth of it. Fair or unfair, he is
there.
On a recent consultation to a young, energetic and bright DC, the very
opposite was found. He is a cash practitioner, subluxation based. His
records were to say the least, "lacking"
He told me very casually and confidently, "my practice consultant says
because I only detect and correct the vertebral subluxation, I don't have to
worry about those medical tests (SOTO-HALL, FORAMINA COMPRESSION, DTR'S
????) But he does have the occasional personal injury case and workers comp
case, and sure, even though he has the occassional Medicare and Blue Cross
case, he relies on his attorney "friends" to tell him what to do.
Living, walking, talking Oxymoron? Foolish? Threatened for sure. It took
only five minutes on a casual "hoody do" welcome to the community meeting to
determine that he too, may be under a microscope and may fall victim to the
political ladder climbing of prosecutors.
While the case of Dr. Kim at the beginning of this post appears to be a
legitimate, well investigated and appropriate indictment of criminal
activity, other innocent D.C.'s will surely fall if they don't take some
effort to get help and determine if their office protocols, regardless of
how simple or complex, are "Squeeky-Clean" It is far too easy in this
complex and fast paced world for any of us to know it all.
Please, monitor your state journals and newspapers and follow the trend in
your area. Make sure that you listen to "self" and the inherent red flags
that are raised within you when you are not sure about something you are
doing. Practice managers are great for patient recruitment and staff
training, but in this day and age, they will drop you like a rock at the
first sign of legal trouble.
William Cockburn, D.C., F.I.A.C.T., B.C.F.E.
Diplomate Forensic Examiner
docbill@earthlink.net "Truth Comes From Within"