SIU Investigation Leads To Chiropractor’s License Being Suspended
On November 3rd, 2011, the Special Investigative Unit of R.J.N. Investigations, Inc. was notified by the Board of Chiropractic Examiners regarding their final decision based upon a documented referral regarding questionable billing practices by J. Ko D.C. In this particular case, the Senior Claims Examiner with Springfield Insurance Company detected initial red flag indicators based upon an analysis of the billing submitted by this chiropractor on several workers’ compensation claims filed against the same employer covered by Springfield Insurance Company. The case was then referred to the Special Investigative Unit for further investigation. In the course of that investigation, the actual medical reports were compared against the billing submitted. Based upon apparent contradictions in the services rendered vs. the billing submitted, this documented referral was then submitted to the California Department of Insurance Fraud Division as well as to the Board of Chiropractic Examiners. The case was subsequently accepted for criminal investigation by the Attorney General’s Office with the State of California. Upon completion of their investigation, a formal complaint was then filed against the chiropractor’s license and the hearing was held on October 3rd, 2011. At the time of the hearing, the chiropractor entered into an agreement to have their license suspended for 30 days effective November 3rd, 2011 and placed on four years probation. As part of the probation, the licensee agreed to submit quarterly probation reports certifying and documenting there has been compliance with all conditions of the probation. Moreover, the licensee agreed to comply with the Board’s probation compliance monitoring program. The licensee was also ordered to reimburse the Chiropractic Board for the cost of their investigation and enforcement in the amount of $15,858. Also, within 60 days of the decision, the licensee shall submit to the Board for its prior approval the name and qualifications of a licensed certified public accountant in this state in a plan by which such certified public accountant would monitor all billing practices. The CPA approved by the Board shall submit written reports to the Board on a quarterly basis verifying the monitoring has taken place as required. As part of this compliance, the licensee shall give the CPA complete access to all fiscal records. The licensee was also ordered to take and pass an ethics examination administered by the National Board of Chiropractic Examiners within the first year of probation.
ABOUT R.J.N. S.I.U.:
Formed in 1996, the SIU Division was created to assist California employers, small size insurance carriers and TPA firms in securing professional assistance so as to detect, investigate and prosecute insurance fraud. To date, the unit has trained well over 1,500 examiners and the documented referrals by this unit have resulted in over 95 convictions for workers’ compensation insurance fraud in California.
ABOUT SPRINGFIELD INSURANCE COMPANY:
Springfield Insurance Company was expressly created to serve the specialized needs of the food industry. As a subsidiary of Unified Grocers, a cornerstone of the California Food Market since 1925, Springfield writes workers’ compensation programs for multiple industries related classifications. Since 1996, Springfield Insurance Company has designated R.J.N. Investigations, Inc. as being their Special Investigative Unit Vendor Manager with the California Department of Insurance.