Federation of Chiropractic Licensing Boards
74th Annual Educational Conference
Seattle, Washington

Fraud In Multidisciplinary Practices
Friday, May 5, 2000

Michael R. Moran, J.D., CFE*
Executive Director & Counsel
Ohio State Chiropractic Board**

• What is a “multidisciplinary” practice?
  
  Historical background - holistic practices
  Current background.
  
  Types of Multidisciplinary practices: M.D./D.C., D.C./D.O., D.C./D.D.S.,
  D.C./P.T., etc.
  
  Examples of Multidisciplinary practice, i.e. Ohio’s Senate Bill 31, other
  examples of this type of practice.
  
  The analysis begins with federal law (i.e. Stark Amendments), your state’s general corporation law, relevant practice acts, etc.
  
  Payment and delivery systems are key.
  
  Operation definitions:
  
  Multidisciplinary practice: A clinic for the delivery of health care
  services integrating providers from differing backgrounds/licensure.
  
  Fraud: A material misrepresentation of fact, justifiably relied upon by a
  third party, to its detriment.
  

• Risk Factors/Problem Areas
  
  Checklist of “Red Flags” (Note: This listing is the beginning, not the end all for regulators. Consult those with expertise in your local laws, rules and situation).
  
  Remember - there are no absolutes in life, in law, or in chiropractic!!!
  
  “Gut Check” Is the primary purpose of the practice to benefit the patients or to benefit the doctors’ financial position? If the answer is that the practice is structured primarily to benefit the doctors’ finances - look out!
  
  Are the doctors employed at the clinic marginal practitioners, i.e. disciplinary history with their state board(s), no DEA certificate, serious
  malpractice history, suspended hospital privileges, spotty job history? If the answer is yes, look out!
  
  Does the practice employ a consultant who makes promises that sound “too good to be true”, i.e., “circumvent limits on chiropractic coverage,” “explode your practice revenues,” “$ 100,000 increased income if the first three months,” etc.?
  
  Is the Medical Doctor fully integrated into the practice?
  
  How is the practice held out to the world? (Is the nature of the practice
  fully disclosed to the public by the nature of the name, i.e. Acme
  Chiropractic and Medical Clinic or is the true nature concealed, i.e. Acme Health Care Center?). What about advertising and soliciting protocols?
  
  Is the actual provider of the services fully and completely disclosed on
  the billing documents (HCFA 1500)?
  
  Does the practice accurately describe the services provided utilizing up to date CPT and ICD 9 coding?
  
  Does each person in the practice have a written job description that is
  adhered to?
  
  Minimizing Exposure
  
  Compliance Programs - Prevention, not a panacea.
  
  Retrospective Audit
  Policies/Procedures
  Ongoing Training
  Reporting & Corrective Action
  Prospective Auditing
  
  Caution is the watchword.
  
  Consult independent legal counsel
  Consult independent financial advisors
  Other subject matter experts, i.e. compliance, investigations, etc.
  Consult all affected licensing boards

• IV.) Regulatory Boards: Part of the Problem or Part of the Solution?
  
  Promulgation of Administrative Rules
  Training of Law Enforcement
  Training/Outreach to Third Party Payors
  Legislative Remedies
  “Doing the Right Thing”
  We must increase our sophistication
  There are no “easy” answers
  Remember our purpose
  
  Case Studies
  
  The D.C. who thought he was an M.D.
  The D.C. who thought he was John Dillinger.
  
  Questions?
  
  Don’t be shy - this might be your last chance for some free advice!!!