Consumer Health Digest #18-07
Your Weekly Update of News and Reviews
February 18, 2018
Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H., with help from Stephen Barrett, M.D. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.
Former hospital owner sentenced for spinal surgery referral scheme. A federal judge has sentenced Michael D. Drobot, who owned Pacific Hospital in Long Beach, California, to 63 months in prison for overseeing a 15-year-long fraudulent scheme that involved more than $40 million in illegal kickbacks paid to dozens of doctors, chiropractors, and others in exchange for referring thousands of patients. The scheme led to more than $500 million in fraudulent bills submitted during its final five years. The kickbacks were financed largely from Drobot's sale of medical devices through his own medical hardware company, International Implants, that were implanted into state workers' compensation patients during the operations. The typical kickbacks were $15,000 for lumbar fusion and $10,000 for cervical fusion surgery. As part of the scheme, Drobot billed an extra $250 per device and paid bribes to California State Senator Ronald Calderon for performing official acts to keep on the books a now-repealed law that required the state to pay the full amount of the invoices. Calderon is now serving a three-and-half year sentence in federal prison after admitting to taking bribes from Drobot and undercover FBI agents. [Former hospital owner sentenced to over 5 years in prison for orchestrating scheme that paid over $40 million in illegal kickbacks to doctors, other medical professionals for spinal surgery referrals. USAO Press Release Number 18-006, Jan.12, 2018]
OIG blasts continuing chiropractic overpayments under Medicare. The Office of the Inspector General of the U.S. Department of Health and Human Services has published a portfolio that summarizes the vulnerabilities identified in previous audits, evaluations, investigations, and legal actions related to chiropractic services under Medicare. [Medicare needs better controls to prevent fraud, waste, and abuse related to chiropractic services. OIG A-09-16-02042, Feb 2018] The report notes:
- From 2010 to 2015, chiropractors had the highest improper payment rates among Medicare Part B providers.
- The improper payment rate for chiropractic services ranged from 43.9% to 54.1%, and the estimated overpayments per year ranged from $257 million to $304 million.
The previous recommendations made by OIG that have not been implemented include:
- implementing and enforcing policies to prevent future payments for "maintenance therapy"
- establishing a more reliable control for identifying active treatment
- setting a limit on the number of chiropractic services to actively treat spinal "subluxation"
- limiting the number of chiropractic services that Medicare will reimburse
The previous recommendations have been ineffectively implemented include:
- ensuring services comply with coverage criteria
- educating chiropractors regarding coverage requirements
In addition to these measures, OIG advises the Centers for Medicare & Medicaid Services (CMS) to:
- work with its contractors to educate chiropractors on the training materials that are available to them
- educate beneficiaries on the types of chiropractic services that are covered by Medicare, inform them that massage and acupuncture services are not covered, and encourage them to report to CMS chiropractors who are providing non-covered services
- identify chiropractors with aberrant billing patterns or high service denial rates, select a statistically valid random sample of services provided by each chiropractor identified, review the medical records for the sampled services, estimate the amount overpaid to each chiropractor, and request that the chiropractors refund the amounts overpaid by Medicare
- establish a threshold for the number of chiropractic services beyond which medical review would be required for additional services
The OIG has been complaining for more than 30 years about Medicare overpayments to chiropractors. Chirobase has a summary of the problem and links to the relevant reports.
"Functional neurology" chiropractor pleads guilty to grand theft. The Sacramento County District Attorney's Office has announced that James Joseph Martin has pleaded guilty to three counts of practicing medicine without a license, four counts of grand theft by false pretenses, and misdemeanor charges of illegally using "MD" and "physician" in advertisements. Martin, who was licensed in California as a chiropractor, promoted himself as Dr. James Martin, D.PSc. in local infomercial advertising. [Egel B. Sacramento chiropractor pleads guilty to defrauding clients. Sacramento Bee, Feb. 14, 2018] The "D.PSc." is promoted as a credential by the Pastoral Medical Association, which describes itself as "a private ecclesiastical membership association with a mission to promote scripture-based health and wellness concepts" and asserts that "regulation of the Almighty's health care concepts is outside the jurisdiction of . . . secular regulatory boards." Martin also portrayed himself as a "Thyroid and Diabetic Specialist," who practiced "Functional Neurology and Metabolic Medicine." The California Board of Chiropractic Examiners has disciplined him twice for misleading advertising.
This page was posted on February 18, 2018