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Desperate Times For Chiropractors?
I subscribe to a number of services that supply news and information about whatever topic I choose to subscribe to. I of course choose chiropractic. More often then not, about twice a week there is a story that pops up in my e-mail box about chiropractic/chiropractors and fraud.
I got my headline for this article from the headline of one of the fraud stories below. I thought that it was on the money. It usually is desperation that causes a DC to commit fraud; however it is on occasion an issue of greed. The need to pay for the big house, the Benz, etc. Unfortunately this leads to more and more risk taking and when the doctor sees that it seems so easy to get away with the doctor starts to multiply the fraud. I’m not going to give a speech or lecture on the moral wrongs of fraud or how when one DC gets a headline like this they kill it for the honest, hard working majority, you already know this. What I am going to tell you is that the articles outline a fundamental problem with the profession as a whole, which is that there are a good number of docs who are not doing well and need help. That is why I am going to try and start a mentoring program. This will be a program where a group of docs from my membership in a given area can sit down with one another 1-2 a month and brain storm.
We don’t want anyone to have to ever resort to this:
CHIROPRACTOR AND ATTORNEY CHARGED IN INSURANCE SCHEME
INDIANAPOLIS - Two people are facing felony charges accused of fraudulently billing insurance companies. The prosecutor’s office says they pulled it off with a few police records.
A chiropractor had his first court appearance Monday and is still in jail for a crime that you could pay for. Robert Ekin used to work inside a building off Meridian Street, but what prosecutors say the chiropractor did inside that building could end up costing you.
“You just never can tell. You see an operation running every day, you just assume it’s running legitimately,” said McKinley Jones.
Jones worked in the same building. He never suspected what some call a “bogus practice.” Ekin is accused of luring car accident victims in for treatment, not doing any procedures but still billing the patients’ insurance companies.
“Typically physicians don’t call you up and say hey come in my office for a free consultation. I know you were in a car accident. This is a very aggressive marketing campaign by this particular chiropractor,” Marion County Prosecutor Carl Brizzi explained.
The prosecutor’s office says Ekin even had an attorney working with him pretending to represent patients to get him more money. Attorney David Wood faces felony charges. The prosecutor’s office says he sent a letter to an insurance company on behalf of a patient demanding the company pay Ekin for his chiropractic services.
HEALTH DEPT. SUSPENDS LICENSE OF CHIROPRACTOR
01:00 AM EDT on Thursday, July 26, 2007By Felice J. Freyer
Journal Medical Writer
The state has abruptly suspended the license of Stephen Jarrow, an East Greenwich chiropractor, accusing him of “serious billing fraud issues.”
Health Director David R. Gifford on Friday pulled Jarrow’s license without a hearing, in what is called a summary suspension. Gifford declared that Jarrow’s continuing in practice “would constitute an immediate danger to the public.”
Bruce W. McIntyre, lawyer for the state Board of Chiropractic Medicine, said that Jarrow, 40, billed Blue Cross & Blue Shield of Rhode Island for services that were not performed for existing patients as well as services for patients he had never seen, usually relatives of his patients. One patient was out of the country on the billing dates. Another had paid out of pocket.
All told, McIntyre said, the Health Department documented roughly 200 instances, involving about a dozen patients, in which Jarrow billed for $65 visits that never occurred.
Jarrow’s office is at 5840 Post Rd.
McIntyre said the matter came to light when Blue Cross subscribers received “explanation of benefits” forms from the insurer listing visits to Jarrow that they knew they’d never made. Blue Cross investigated and contacted the chiropractic board.
The board asked Jarrow for documentation, and Jarrow said it all had been destroyed when he switched to electronic records, according to McIntyre. When the board subpoenaed his records, he did not have acceptable medical records but instead supplied “a collection of encounter forms that were allegedly signed by the patients,” McIntyre said.
The chiropractic board has scheduled a hearing for Monday. It also referred the matter to Attorney General Patrick C. Lynch.
Neither Jarrow nor his lawyer, Christopher J. Petrarca, could be reached yesterday.
CHIROPRACTOR SENTENCED FOR FRAUD
Charlotte Business Journal - July 13, 2007
A local chiropractor has been sentenced to two years in federal prison for health-care fraud, money laundering and bank fraud.
The charges against Mark Cox were connected to his Mecklenburg County businesses, Diagnostic Testing Services Inc., Southeast Medical Management Inc. and Total Care Family Health Center.
In 2005, Cox pleaded guilty to submitting more than $360,000 in false health-care-related claims and laundering the proceeds.
In addition, he pleaded guilty to participating in a $2 million fraud on Wachovia Bank, acknowledging he made false statements on loan applications.
Cox was also required to forfeit his chiropractic license, and he will not be eligible for reinstatement during his federal sentence.
He was ordered to pay a $50,000 fine, pay $1.4 million in restitution to Charlotte-based Wachovia and several insurance companies and forfeit $1.4 million to the government.
DOCTOR PLEADS GUILTY TO FRAUD
A Savannah doctor pleaded guilty Thursday to participating in a $5 million scheme to defraud health care insurance programs.
The U.S. Attorney’s Office says Rafael G. Razuri, who was an owner of Southside Medical and Rehabilitation Center, admitted
conspiracy to commit health care fraud.
A co-defendant, Eric J- Baty, a chiropractor formerly of Savannah, pleadedd guilty to the same charge on June 4th.
Razuri was indicted in January after a federal and state investigation into billings to Medicare, Georgia Medicaid and private insurance companies for physical therapy services to Southside patients.
The prosecutors say that evidence showed that from July 2000 through June 2005, Razuri conspired to bill more than $5 million in fraudulent physical therapy claims, and to defraud private insurers by creating false records of automobile
accident victims.
Razuri remains free on bond pending sentencing, which has not been scheduled.
The offense carries a penalty of up to five years in prison and a $250,000 fine.
DALLAS ACCIDENT CLINIC FOUND GUILTY
A Dallas jury has ruled that Texas’s largest chiropractic chain, Accident & Injury Pain Center, Inc., conspired in a statewide scheme designed to defraud Allstate Insurance Company and Encompass Insurance, an Allstate subsidiary. The Center, its related entities, and various chiropractors, osteopaths and medical doctors were found to have conspired to commit common law fraud by overtreatment and unnecessary referrals. The jury ordered them to pay $2.8 million in actual damages and $3 million in punitive damages.
MINNEAPOLIS CHIROS SUED BY INSURERS
Five national auto insurers sued five Twin Cities chiropractors Wednesday, accusing them of steering accident victims to their clinics and submitting more than $1 million in bogus insurance bills over two years. Court documents said the clinic owners used accident reports to find victims and then solicited them by phone to come to the clinics. The suit says the clinics also used “runners or cappers” to find and transport the victims to and from the chiropractors, a practice that became illegal in Minnesota this month. Some insurance executives said that Minnesota’s fraud problem has been exacerbated by the lack of a state insurance-fraud investigation unit, as well as by the state’s no-fault insurance system.
KINKY THERAPY FOR YOUR BACK
Desperate times for chiropractors drive some to set up shop with prostitution rings, officials say. Operators say they were tricked.
By MONTE MORIN
Times Staff Writer
“Dr. Jim” pitched himself as the ultimate New Age healer, a chiropractor who also practiced electro-acupuncture and hypnosis and dispensed botanical elixirs.
James F. Aquila promised to remedy life’s stresses and addictions with a blend of spinal adjustments, counseling and “psychobiochemical” therapy. Relief, he wrote, was just a matter of “utilizing the mind/body connection” and “channeling spiritual flow.”
Authorities have a simpler term for what went on at Dr. Jim’s Midnight Therapy in Anaheim: prostitution.
The “therapy,” prosecutors say, consisted mainly of young women in metallic miniskirts performing sexual acts for cash. Aquila is to stand trial later this year on charges that he operated a house of prostitution, using the chiropractic clinic as a cover.
Driven by police from their longtime haunts on street corners and massage parlors, prostitution rings are setting up shop in suburban strip malls, medical plazas and business parks–often using chiropractic offices as a cover.
Web sites provide clients with rankings and directions to these clandestine establishments. The operators try to frustrate law enforcement by constantly changing the roster of prostitutes and by training the women to spot undercover cops.
Over the last year, police in Anaheim have raided five chiropractic clinics alleged to be fronts for prostitution. Los Angeles police have raided 18 chiropractic establishments since October, mostly in the San Fernando Valley.
The state chiropractic board, meanwhile, has stripped 11 practitioners of their licenses for involvement in prostitution over the last two years. The board is investigating similar allegations against 20 other chiropractors.
“It’s a problem that’s only escalating,” said Catherine Hayes, enforcement program manager for the board. “We get calls about this every day from law enforcement. It’s giving the profession a black eye.”
Why is this happening? Authorities say a financial squeeze on chiropractors has left some of them desperate enough to share their premises with prostitution rings, whose leaders are always looking for respectable fronts to hide behind. The rings are believed to have ties to Asian organized crime.
Times are tough for California’s 12,500 active chiropractors. HMOs have slashed their reimbursements and reduced the number of chiropractors included in their health plans. Yet the ranks of practitioners keep growing, up 30% in California over the last decade. Many struggle to cover rents and pay off school loans that often exceed $100,000.
“It’s a reflection of absolute desperation,” said Robert Dubin, a chiropractor in Petaluma and president of the California Chiropractic Assn. “Why else would anyone risk their license after investing all that money and time just to make some quick cash on hookers? Employment opportunities for chiropractors are getting few and far between.”
“Dr. Jim” Aquila says it was financial desperation that landed him in trouble.
Aquila, 65, who grew up in the Chicago area and studied psychological counseling at UCLA, has been a licensed chiropractor for more than 30 years. He’s described on several holistic health Web sites as a “life coach” who counsels people in how to handle stress.
In recent years, he had trouble drawing patients to his Placentia practice. He filed for bankruptcy in 1995, listing more than $200,000 in debts. The state filed four tax liens against him totaling $70,000.
His financial woes worsened when he and his wife separated several years ago, he said.
“The bills were mounting,” Aquila said in an interview. “There was just this unbelievable set of circumstances that have hit me.”
By last year, Aquila was reduced to treating neighbors and friends in the garage of his Diamond Bar home. Thumbing through the local paper one day, he saw an ad he thought could turn his career around. The ad sought a seasoned chiropractor to run a new office in Anaheim.
“It was for $40 an hour, which looked good to me,” said Aquila “I didn’t think too much about it. They assured me everything was on the up and up.”
He declined to identify the people he says hired him, and police refused to say if they were investigating others in connection with the establishment.
The job didn’t require Aquila to do much. He sat in the clinic, performing little if any therapy. The office employed several female masseuses, whom he was supposed to supervise.
Aquila said he had no idea the women–with nicknames like “Rosie” and “Kinky”–were prostitutes until police raided Midnight Therapy last June, arresting Aquila and three “therapists.”
“I’ve been chosen as the scapegoat,” said Aquila, who has pleaded not guilty to amisdemeanor charge of operating a house of prostitution. “I needed money at the time. I had no intention of doing what the police say I did. My God, I had 30 years of practice! To end it this way is just very humbling.”
Anaheim police maintain that Aquila was a willing participant in the prostitution operation.
Midnight Therapy’s storefront was in a bland stucco shopping plaza on Broadway, a few miles from Disneyland. Investigators said there were no X-ray machines, bone charts, ultrasound machines or other medical equipment commonly found in chiropractors’ offices.
Instead, they found $1,300 in cash and copies of advertisements in Vietnamese-language newspapers describing Midnight Therapy as a place where “girls happily serve your every need.”
Police and neighbors say the operation catered exclusively to male customers, who would sometimes wait furtively in the parking lot and toss condoms on the asphalt after leaving.
“Oh yes, they were busy. Extremely busy,” said Angel Ergun, a bridal wear supplier who leases space next door. “I heard a lot of what was going on. I had to hit the wall. I said, ‘Enough!’”
The masseuses wore miniskirts and tightfitting, low-cut tops, according to affidavits by undercover investigators. On one occasion, an undercover officer said, he complained to Aquila that a masseuse had refused to give him a “special massage.”
Aquila allegedly told him to ask for a different woman–”Rosie”–on his next visit.
As one of America’s biggest tourist destinations, Anaheim has long struggled to rid itself of prostitution. The city drove out most of the hookers who hung out in front of neon-lit motels near Disneyland in the early 1990s. Some rings then moved into massage parlors.
Anaheim–along with many other cities–responded with ordinances requiring all massage employees to get police background checks, receive certification and undergo training. Nearby Westminster is considering a proposal to require massage operators to undergo medical tests for sexually transmitted diseases.
Now, the prostitution rings are moving out of those locales and into storefront businesses.
“We used to experience the normal types of prostitution”–street walkers and call girls, said Westminster Police Det. Tom Rackleff. “But right now the prostitution is in the workplace. Shutting these places down has become a very difficult game of cat-and-mouse.”
The fronts usually operate for months before neighbors complain or a customer’s wife or girlfriend tips off police. Other operations soon spring up to take their place, with prostitutes trained to foil undercover police operations.
“They know … what we’re looking for,” Rackleff said. “Most of the girls know how undercover officers operate. They look for wires. If someone is new, they won’t solicit you unless you make a provocative act first. And if that happens, they can use that as a sexual assault charge in response.”
Chiropractic offices are attractive as fronts for prostitution because of the way they are regulated.
Although chiropractors must be licensed, the state allows them to hire unlicensed assistants. By contrast, assistants at massage parlors often are required to hold massage licenses and register with city officials.
“I don’t think any of these chiropractors set up to have prostitution be a part of their business, but there are some who are looking to supplement their income,” Rackleff said. “Often they’re approached by a business manager who says they can increase their income with a variety of massage therapists ….It’s a wink-and-nod type of thing. They say, ‘Just pay me some money to use the room. Don’t ask, don’t tell.’”
Something just didn’t look right about Anthony Wassif’s chiropractic clinic in Commerce, city officials say.
It was in an industrial area, and the only entrance was from a back alley. Inside were 12 private rooms, showers and video cameras. A sign at the front door advised clients not to submit to a police search unless the officers produced a warrant.
City officials shut the Commerce Chiropractic Clinic earlier this year. Several other offices operated by Wassif have been raided by Los Angeles police. Wassif, 34, has not been criminally charged, but the state’s chiropractic board is trying to strip him of his license, alleging that his eight chiropractic clinics in Southern California are actually houses of prostitution.
Wassif maintains that he was duped. His story sounds eerily like Aquila’s.
Wassif said he answered advertisements in local weekly papers that promised to pay willing chiropractors up to $1,000 a week. The deal was that Wassif would apply to the state for a so-called satellite license, allowing him to operate multiple chiropractic clinics, and a behind-the-scenes owner would run the facilities.
Wassif said he never knew anything illegal was going on.
“There’s a lot of false information flying around out there,” said Wassif, who lives in West Hills. “It’s very tough right now for chiropractors to make money. They get tricked.”
Wassif declined to identify who hired him. “I don’t want to have health problems, if you know what I mean,” he said. “They’ve been around for a long time. First, they’d used acupuncture and acupressure places and then they realized massage was allowed in chiropractors’ offices.”
Raymond Ramirez, assistant director of community development for Commerce, said he is convinced that a prostitution ring was pulling the strings at Wassif’s Commerce Chiropractic Clinic. “This is not small peanuts,” he said.
The premises that Wassif used were leased by a man suspected of running chiropractic offices that front for prostitution in Inglewood and other communities, Ramirez said. The man hasn’t been charged with a crime, and Los Angeles County authorities declined to say whether they are investigating him.
Police investigators across Southern California are comparing notes in an effort to identify the people who recruited Wassif and other chiropractors and paid their rent. Officials said the prostitutes and chiropractors who have been arrested in different places are often represented in court by the same defense lawyer.
“We’ve got pretty good indications that there are elements of Asian organized crime behind it,” said Sgt. Marcus Frank, a vice investigator at the Westminster Police Department. “There is definitely an organization that is recruiting the women, training the chiropractors how to do it and evade the police, and giving them legal help.”
Birch Acu-Therapy was tucked amid suites of lawyers, real estate agents, engineers and communication firms in a smoked-glass office building in the Santa Ana Heights area near Newport Beach.
Men driving Jaguars, Mercedes and BMWs marched up to the office for what neighbors thought was legitimate therapy. They were shocked when sheriff’s deputies swept in, arresting the chiropractor and several female assistants in March.
“I’m totally mortified,” said Shawna Pierno, the building’s property manager. “This is just so embarrassing…. I always thought they were good tenants. They were quiet and they always paid their rent on time.”
Authorities contend that Birch Acu-Therapy was a high-end prostitution service that brought in undocumented young women from Los Angeles’ Koreatown by taxi each morning to serve as “therapists.”
For several weeks after the arrests, a stream of patrons continued to arrive in luxury cars, apparently unaware that Birch Acu-Therapy was no longer in business.
One regular, a 40-year-old construction contractor from Los Angeles who declined to give his name, said the operation was upscale and “professional.” The amenities, he said, included private showers, tranquil posters of mountains landscapes and classic rock music piped into the three bedrooms.
“It’s too bad. This place was above-average,” he said. “I drove more than half an hour just because of that. It’s kind of like when you have a favorite restaurant, a place that’s clean and you like what they have on the menu. Why go someplace else?”
STATE CHIROPRACTOR ACCUSED OF INSURANCE FRAUD
HIS LAWYER SAYS COMPLICATED MEDICAL RECORDS LED TO MISTAKEN ALLEGATIONS
JoNel Aleccia
A Post Falls chiropractor has been indicted on 70 counts of insurance fraud in U.S. District Court.
Timothy Grothman, owner of Health Within Chiropractic Center, pleaded not guilty last week to federal charges that he billed insurance companies in Tennessee and elsewhere for dozens of services he didn’t perform.
Grothman, 52, is accused of double-billing, billing for services he didn’t provide, and charging new patient fees for examining existing clients between 1998 and 2003, according to court records.
Grothman’s lawyer, however, said Wednesday that the allegations are a mistake sparked by confusion over complicated records.
“Truth be told, it’s nothing but a medical code error,” said lawyer Mark Vovas, who called Grothman “a darn good doctor.”
Vovas added that the matter was abetted by what he described as “a couple of disgruntled employees.”
The indictment alleges that Grothman planned and executed a “scheme” to defraud several health care benefit programs, including Midwest National Life Insurance Co. of Tennessee and others.
It said that Grothman billed for therapy services that he didn’t provide, billed two or more insurance companies for services offered on the same date and billed for new patient exams while also billing another company for services to the same client.
Chiropractor convicted of fraud
The Associated Press
PITTSBURGH (AP) - A former chiropractor was convicted on charges he defrauded insurance companies.
A federal jury on Friday found Brent J. Detelich, 37, of Clearwater, Fla., guilty of one count each of health care fraud and mail fraud.
Prosecutors accused Detelich of submitting fraudulent claims to Highmark Blue Cross/Blue Shield for services not rendered. When the insurance company paid the claims, Detelich split the payments from those false claims with some patients, prosecutors said.
July 14, 2007
Chiropractor arrested while awaiting trial
A Marion Superior Court judge on Friday ordered an Indianapolis chiropractor back to jail for 10 days after he was arrested while awaiting trail in an insurance fraud case.
Robert Ekin, 38, was out on $20,000 bond when he was arrested last week on a public intoxication charge. Judge Tanya Walton Pratt gave Ekin a stern warning that if he violated his conditions of release again, she would keep him in jail until his case ended. He also must undergo alcohol abuse treatment, she said.
Court documents allege Ekin and Midtown Chiropractic billed auto insurance companies for tests and services never performed on people involved in car crashes. Ekin denies wrongdoing.
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I have spoken to my friend Ted Koren, DC, he has agreed to do a conference call in January, I’ll let you know the date in the next newsletter. I am also trying to get the worlds greatest expert in “Lumpy Mail” as a conference call guest. All for you, all for free.