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Health care fraud: chiropractors, doctors and billing practices

Chiropractors and doctors have historically been much at odds. Their respective approaches to the healing arts have kept the two professions from seeing eye to eye with each other.

But practitioners of either profession can get in trouble for billing irregularities. In a recent Missouri billing fraud case, a federal judge sentenced a chiropractor to prison for six years. The judge also ordered the chiropractor to pay restitution of $1 million.

The case involved fraudulent billing of insurance companies, as well as patients. The bills were for services the patients did not actually receive. 

Fraudulent bills, however, were not the only problem. The chiropractor's practice also used pension plan funds for an improper purpose: buying stock and condominiums.

The chiropractor was convicted last fall of health care fraud. He was also convicted on three counts of making false statements concerning health services. 

The chiropractor's business was also convicted on several charges. The practice has been placed on probation for two years. It must also pay an assessment of $2,000.

The investigation that led to the convictions focused largely on false X-rays. The X-rays were false in that typically only one or two were taken of a patient, but the office often billed for from eight to 12.

The aspect of the case that concerned the practice's pension plan did not only lead to a mail fraud conviction against the chiropractor. A billing assistant pleaded guilty to making false statements. She has been placed on probation for five years and must pay $120,000 in restitution.

Beyond this case, the larger story we have been following in this blog concerns new rules on fraud and false claims under the Affordable Care Act. We discussed that issue in our February 25 and will continue to follow it.

Source: "Chesterfield chiropractor sentenced to 72 months for billing fraud," St. Louis Business Journal, Samantha Liss, 4-23-13

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