Archive for the 'Legal Alerts' Category

Jun 16 2009

Craig F. Buhler, D.C. Utah ACA Delegate

Published by dramon under Legal Alerts

Dear Utah Chiropractors;

 

I am writing this letter with deep concern for the future of your practice and the welfare of you, your families and patient’s. As you know, President Obama is committed to passing national health care reform. He and the Democrats have been feverishly working to come up with a package that will completely remodel the health care system. There are three separate groups who are writing different bills to present to congress. None of these three bills at this point include chiropractic coverage. Contrary to what the media is reporting, the Democrats are not including the Republicans in the process. Senator Hatch and a number of other Republicans who have been such great supporters of our profession can not help our cause and so it is more critical than ever that all of us work to make sure that we are included in the new national health plan.

All the studies that have been performed in corporations using the chiropractic wellness model have shown impressive cost saving in medical expenditures. We are an important part of the solution of the current health care crisis. When the national health care plan is passed in what ever form it is, millions of Americans will be accessing more affordable care. This stands to dramatically increase the need for more physicians to supply the demand. Four thousand general practice M.D.s will be retiring this year and the AMA is moving to remove all competitors from the system. Who will supply the demand for physicians? President Obama has stated clearly he wants any national plan to be similar to Medicare and the Blue Cross/Blue Shield Federal Employees Health Plan. Both of these plans spell out specifically that services are rendered by physicians. The American Medical Association in their last conference voted their number one legislative agenda is to pass legislation making it a felony for anyone other than a M.D. or D.O. to us the term “Physician”. This is an effort to carve chiropractic and any other provider group out of the plan. As you all know, Medicare will not allow us to bill or charge patients for the chiropractic service. We are r equired by law to bill Medicare. The threat is we may not be allowed to treat patients or if we are allowed to treat them, it will be based on a referral from an M.D. or D.O. California has alresdy passed such legislation. We could all be out of practice with the stroke of a pen. Some of you have indicated you would simple go to a cash practice. My question to you is, if every American is under national health care, as all Americans over 65 are under Medicare, who will you legally charge cash from?

The plans also include a provision that requires scientific evidence for procedures used in order to be reimbursed for those services. How many studies show the techniques you are presently using are effective? Even if chiropractic is included in the plan, are you willing to limit what you do because you can not show, based on research, that your technique or procedures works?

Our profession is faced with the most critical challenges in its history. I have spent hundreds of hours on my days off traveling the state visiting many of your offices. I have made hundreds of phone calls and sent out numerous emails trying to get you to join the ACA, ICA and get your patients to go on line and register on

www.chirovoice.org in an effort to get moral and financial support to address the issues that we all face. Many of you committed to me that you would join and have your patient’s sign up for chirovoice. To date none of you have joined and we only have 137 patients who have registered on the chirovoice site in the state of Utah. Frankly, I have never worked so hard for anything and accomplished so little. This is not about Dr. Buhler if any of you have issue with me. This is about you and the future of your profession. I have seen what you all have created thru your apathy and inaction in this state. If it were not for the very few amazing doctors willing to put their butts on the line that we have the practice act we have. It is one of the best in the country.

 

www.chirovoice.org

so that we can impact congress and direct the outcome of the national health care plan. Have everyone you know contact their representatives in Washington to include chiropractic in the plan. Use the chirovoice site to help you. We are cost effective and can compete if we are allowed. Can you imagine what we can accomplish if 60,000 chiropractors and their patients contacted their representatives in an effort to impact our level of participation in national health care?

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Jun 09 2009

Council on Chiropractic Guidelines & Practice Parameters

Published by dramon under Legal Alerts

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Jun 09 2009

Lawsuit - 2009

Published by dramon under Legal Alerts

The Utah Chiropractic Physicians Association needs you and your Chiropractic Friends to notify us of any requests for money back from Aetna, for any reason! Dr. Knight jknightut@juno.com

We are moving toward joining the Aetna Class Action Lawsuit. This is the kind of information that we need documentation for: 1. Challenge how Aetna determines the usual, customary and reasonable (”UCR”) rates for services provided by out-of-network chiropractors.

2. Challenging Aetna denying services for Intersegmental Traction, Surface EMG, Dry Hydro therapy, or any other serice that is traditionally done in Chiropractic Offices that is being denied because they purportedly have not been demonstrated to be safe and effective. 3. Also evidence of any refunds being asked for relating to the above challenges.

Your timely documentation of activities of this kind would be greatly appreciated.

James D.Knight,D.C. Member of Utah Chiropractic Licensing Board Chairman UCPA Legal Legislatice Committee  
Attorney Brian Hufford, a partner at a New York law firm with an office in Columbus, Ohio, is working on class action lawsuits against Aetna and Cigna alleging that the companies have denied payments for chiropractic services pursuant to their health care plan’s experimental and investigation exclusion.  UTAH DC’s who have experienced take-backs or care denials from Aetna or Cigna which are related to the experimental or investigation exclusion should contact the UACP at
In addition to these issues, Mr. Hufford is challenging how Aetna determines the usual, customary and reasonable (“UCR”) rates for services provided by out-of-network chiropractors.  In making its UCR determinations, Aetna uses a database it has licensed from Ingenix, Inc., a wholly-owned subsidiary of United Healthcare Group.  Mr. Hufford was co-lead Counsel on behalf of the American Medical Association in an action against United Healthcare claiming that the Ingenix database is inherently flawed and cannot provide a valid basis for setting UCR rates.
The lawsuit led to a probe into the independence of the Ingenix database by New York Attorney General Andrew Cuomo.   In January, UnitedHealth struck an agreement with Attorney General Cuomo to give its control of the Ingenix database to a public health school, which will create a new database under the oversight of the Attorney General’s Office.  United Healthcare also agreed to pay $50 million toward the funding of the new database, to which $20 million will be added from Aetna, pursuant to its own agreement with the Attorney General.  In addition, Mr. Hufford’s firm has negotiated a $350 million settlement fund to resolve the class action, which is currently being evaluated by the New York District Court for preliminary approval.  Last year, the District Court in New Jersey approved a similar settlement with Health Net, valued at $250 million, based on claims asserted by Mr. Hufford and his co-counsel, arising from Health Net’s reliance on the Ingenix database to set UCRs.
The effects of these lawsuits and judgments continue to ripple through the medical community.  Another class action lawsuit led by the American Medical Association alleges that the largest health insurer, WellPoint, also used the flawed database to undercut payments to physicians.  The suit, brought by the AMA, four state medical societies, and two California doctors, charges that WellPoint based its payment rates for non-participating or out-of-network physicians on skewed data from the flawed database. 
UACP leadership has been in contact with groups affected by this litigation and will continue to monitor future developments.  If your practice has been impacted by the insurance actions, please contact Tim Apgood, UCPA Executive Director  801-281-4100  tim@fscpa.net

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Oct 17 2008

Message from Attorney Randal Meek

Published by dramon under Legal Alerts

Check out this month’s message from Randal Meek… Continue Reading »

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Oct 17 2008

Decompression Article gives helpful info- Check it out

Published by dramon under Legal Alerts

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Jul 20 2008

Randal Meek: “Lawyers who care, serving you”

Published by dramon under Legal Alerts

News from the “Front Lines in the PI War”

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Jul 02 2008

Caution! PI Marketing may be Illegal…

Published by dramon under Legal Alerts

PI Marketing is great and legal if done right.  If done wrong you may be in violation of the law and it may cost you your license to practice and even possible charges of criminal fraud.

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May 23 2008

Informed Consent

Published by dramon under Legal Alerts

Jim Knight showed this interactive DVD program covering Informed consent at the May Board Meeting.

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Apr 01 2008

Ethical Standards - Advertising Responsibilities

Published by dramon under General, Legal Alerts

Advertising Responsibilities for Utah Chiropractic Physicians

In addition to Utah Chiropractic Physician Practice Act, Title 58, Chapter 73 and it’s associated rules, R156-73, Utah Chiropractic Physicians are regulated by the Division of Occupational and Professional Licensing Act, Title 58, Chapter 1 and its associated rules, R156-1. Title 58, Chapter 1, 501 Unlawful and Continue Reading »

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Mar 29 2008

Ethical Standards

Published by dramon under Legal Alerts

Ethical Standards Adopted by the Utah Chiropractic Physicians Association

Please be advised that all advertising, signage, letterhead, business cards, etc.. need to indicate who and what your are!  Failure to do so is considered false and misleading advertising.  Saying that you are doctor so and so, without in someway indicating that you are a Chiropractic Physician/Chiropractor may be looked as practicing medicine without a license, since you may bemisleading the public into thinking that you are something other than a Chiropractic Physician/Chiropractor.  Blind advertising in which you claim to provide a service without identifying your clinic, the doctor and specialty is false and misleading advertising, and unethical and unprofessional conduct.

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