An attorney writing in a chiropractic periodical reported hearing a scary story from a chiropractor that goes: Chiropractor hired a consultant to conduct an audit of his practice, and on completion of the audit the consultant demanded a low five-figure payment from the chiropractor to ensure compliance and implementation of recommendations. The chiropractor declined to pay for the extended services and several months later the chiropractor was contacted by the government who were focusing on the same problems highlighted by the consultant.


The problem with this story is that no substance is provided to allow readers to evaluate the validity of the events claimed. Another BIG PROBLEM is that the attorney fails to mention that frequently providers may seek out audit and compliance services because they already suspect they are being investigated! However, in reading the attorney’s entire article its purpose is clear – health care providers should exercise appropriate due care prior to, during and after their decision to audit their health care practices!


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Advertisements are being sent to doctors from a California company asking if TENS/EMS units are being prescribed to patients for home use? The company reports they can show how to give patients drugless pain relief and add a new profit center to the doctors office.


The company says their program is simple - they sell TENS to doctors for $29.00 (when 2 or more ordered) and instruct the doctor on billing procedures for the TENS and fitting fee where the profits range from $200.00 to $600.00 per unit depending on the type of insurance coverage and amount charged for the unit/fitting fee. Next, the company provides the patient with necessary supplies (batteries, pads & wires) and bills the insurance company direct.


Good deal? Maybe. I would recommend that doctors check it out first with their attorney familiar with state practice laws.

A doctor called and asked: Is it true that providers would get in trouble for not purchasing services from a seminar speaker should federal investigators look at them. The caller added that the speaker told the seminar audience he provides the list of seminar attendees to the FBI and that if one of the attendees was investigated by the Fed's it would be used against them if they were at his seminar but did not purchase his services.


I have provided training to health care providers in excess of 10 years and I have never given or been asked by law enforcers for a list of attendees. But this speaker could in fact be giving his attendee list to the FBI - I don't know. And, for more than twenty years I have been in investigations and I could see, with my investigator hat on, how law enforcers could use this info for intelligence purposes but the info, in of itself, would be of minimal value unless there were suspicions that a doctor having attended the seminar was engaged in misconduct, and then it could be used in developed fraud cases with established evidence to support that violations of law were done purposefully - where the list could be used to show the provider knew what they were doing was wrong and that they purposefully engaged in criminal conduct.

I was recently told by a compliance client that they had previously used another consultant for compliance who reported that by placing his (consultant's) compliance certificate on the wall in plain view for those coming into the clinic that if an investigator comes in and sees the certificate they will immediately turn around a leave because they will know the clinic is in compliance once they see his certificate.


Over the years I have heard of and seen people who wield alot of power, but I have never heard of anyone in the compliance arena having that much power!


And, I thought I had it going on.

Yesterday I received via email a compliance test in an advertisement. I took the test, which by the way is an interesting tool to facilitate interest in compliance. Anyway, the test consisted of a number of questions with multiple choice answers that were immediately scored by clicking the submit answer icon to tell you if you were correct or incorrect. I noted in taking the test that a number of the graded correct responses may not, in my opinon, be the best choice as the correct answer from a compliance perspective.


For example, one of the questions asked was what code would you (the doctor) bill on the first visit if a patient was referred by another healthcare specialist? The correct answer per the test was 99243, with the other choices being 99233, 99203, and 99213. The correct answer is "IT DEPENDS"! If the healthcare specialist who referred was not a physician would it still be a 99243? What if the components for this level of consult were not met would it still be a 99243? What if the physician just referred the patient for chiropractic care would it still be a consult at any level...