MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

It has been reported that the US Insurer ‘State Farm’ is fighting a fraudulent scheme that has been exploiting New Jersey’s personal injury protection (PIP) benefits law since 2014. The insurer is seeking to recover $2.6 million in what it claims are fraudulent auto injury claims and a declaratory judgment that it need not pay any further claims submitted by the providers involved in the alleged scheme.

State Farm’s suit accuses 12 chiropractic and spine clinics and doctors of fraud, unjust enrichment, and violations of the New Jersey Insurance Fraud Prevention Act. The insurer alleges these providers used a “predetermined protocol” for all patients and a patient referral system for services that were either not performed or were not medically necessary for the individual patients. Instead, the services were carried out to enrich the defendants by exploiting the patients’ eligibility for PIP benefits, according to the complaint.

The suit accuses the providers of failing to legitimately evaluate patients to determine the true nature of their injuries and of reporting the same or similar findings for all patients to justify a predetermined course of treatment that was substantially the same for all patients. Part of the “predetermined protocol” for patients with soft-tissue injuries of the neck and back consisted of

  • hot and cold packs,
  • chiropractic manipulations,
  • massage,
  • mechanical traction,
  • physical medicine and rehabilitation,
  • and manual therapy.

These treatments were administered to almost every patient on almost every visit, regardless of each patient’s unique circumstances and needs, according to the complaint. The chiropractors are also accused of referring patients to diagnostic clinics, some allegedly illegally owned by the chiropractors, for an “unnecessary and predetermined course of pain management and invasive treatments” including injections. State Farm says they would submit false documentation for each case representing that the treatments were legitimately performed and medically necessary.

The 80-page complaint details case after case where the patient’s responses to questions and tests were the same or similar, allegedly serving as a “pretext to justify” the chiropractors’ wide range of treatments. The defendants in the complaint filed in U.S. District Court for New Jersey are:

  • Tri-County Chiropractic and Rehabilitation Center,
  • Robert Matturro, D.C.,
  • Advanced Spine and Pain Management,
  • Varinder Dhillon, M.D.,
  • Nicholas Rosania, D.C.,
  • Bloomfield UAI,
  • Dov Rand, M.D.,
  • Primary Medical Services,
  • Louis J. Citarelli, M.D.,
  • Chiro Health Center P.C.,
  • Marc Matturro, D.C.
  • Marco Tartaglia, M.D.

_____________________________

This story made me wonder: which of the listed treatments

  • hot and cold packs,
  • chiropractic manipulations,
  • massage,
  • mechanical traction,
  • physical medicine and rehabilitation,
  • and manual therapy

would ever be indicated for patients with soft-tissue injuries of the neck and back? Or more specifically, are chiropractic manipulations indicated or contra-indicated for such problems following a car accident? I fail to see any sound evidence that they are effective. If I am correct, should insurance companies not sue all chiropractors who routinely use manipulations for such cases? If the answer is YES, the sum of 2.6 million might need to be increased by several orders of magnitude.

47 Responses to A $2.6M Insurance Fraud by Chiropractors and Doctors?

  • A real tempest in a teapot. Medicaid/Medicare fraud is uncountable billions every year. It is so routine that it is rarely reported.

    • Ahhh – that’s alright then!

    • But this is a double fraud. Sure, there’s real treatment for fake injury but this is about fake treatment for fake injury.

      • A lot of Medicare/Medicaid fraud is charges for no treatment. They just submit a bill and get paid.
        I am not supporting any fraud. If none of this chiro helped people and wasnt designed to then it is fraud.
        But chiro does help people, and a story like this doesnt invalidate it.

        • “But chiro does help people”
          In what way?

          • All I can give is anecdotes. Its helped me and others that I know. I am not on this site to primarily talk about chiro. I will let chiros do that. I will say that the chiro treatments that I have had, the results are not long lasting. It needs other supportive treatment or supports, imo.

          • so, you have no evidence.

          • actually, anecdotes are usually considered low level evidence, along with expert idea or opinion.

          • Good thing the scientific method doesn’t rely on any of those then.

            And that chiropractice have yet to meet the burden of proof for multiple things it has been claimed to help with.

            Same as any other scam, really. It’s just sad to see people defend snake oil peddlers, even in 2022.

          • JR: Good thing the scientific method doesn’t rely on any of those then.

            They are not completely ignored either.

        • You say chiro does help but it’s not long lasting. I can’t speak for chiro but I have a little experience of shiatsu. I should say from the outset I think it’s total nonsense but a very dear friend who believes in it insisted I should let her try. So I humoured her, just the once.

          Yes, I did feel quite relaxed afterwards. Why wouldn’t I? I’d spent an hour lying on a comfortable mat being made a fuss of by someone I like. Did it help my aching hips and legs? Of course not.

          • I had about 4 months of pain in my hips from over-doing an HIT workout. One session with the chiro solved the problem permanently. He did an adjustment that resolved the pain immediately and gave me a lift for one shoe that prevented it from returning except when I tried to go without it.

  • EE: Or more specifically, are chiropractic manipulations indicated or contra-indicated for such problems following a car accident?

    Well, injuries after a MVA are graded from 1 to 5 and there are 4 stages of healing. Thus one needs to be specific, as treatment options will vary depending on the grade and stage.

    • so then, be specific and show me the evidence that SMT works for any of the grades.

      • it’s your request thus you need to be specific.

        And you didn’t ask for evidence, you asked for indications and contra-indications.

        • so, you don’t have evidence!

          • you originally asked for indications and contra-indications.

            “Or more specifically, are chiropractic manipulations indicated or contra-indicated for such problems following a car accident?”

            You want evidence that spinal manipulation is contra-indicated for a grade 4-5 whiplash? That should be self-evident.

          • what a fuzz you make when you have no evidence!

          • it’s a fuss trying to get you to be specific.

            But anyway…

            “Based on a small RCT (level II)64 and three systematic reviews (level II)58,61,65 there is grade C evidence that thoracic manipulation may be effective in the treatment of acute WAD. Further high quality RCTs are required before manipulation would be routinely recommended for the treatment of WAD.” State Insurance Regulatory Authority: Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney: third edition 2014.

            Care to move the goalpost again?

          • no need for moving anything; the evidence is most unconvincing

          • EE: the evidence is most unconvincing

            I never claimed it was.

            You stated I had no evidence. You were wrong.

            Of course this has nothing to do with indications/contraindications.

          • did I really?
            I rather think you are foaming from the mouth and thus unable to read what I wrote.

          • The problem seems to be that I read what you originally wrote, I responded specifically to what you wrote, you realized what you wrote was not what you meant to write so you then changed the topic.

            Once the topic was changed you claimed I had no evidence, I thus provided some evidence and then you decided to qualified the evidence.

            Moving goalposts.

            It’s clear you can’t or won’t have a discussion on the topic.

            Good day.

          • No, the problem is that you read what I never wrote. Here is the original passage:
            “I fail to see any sound evidence that they are effective.”
            This you managed to turn into this:
            “You stated I had no evidence. You were wrong.”

            YOUR PRO CHIRO BIAS MAKES YOU BLIND!

          • Two separate sentences. Two potentially different topics which is why I attempted to get you to be specific. But perhaps the topic is beyond you knowledge base. So be it.

          • 1) a lot here seems beyond your intellectual capacity.
            2) in a discussion, one can and usually does deviate from the original focus [something you erroneously call ‘moving the goal post’]
            TIME TO ADMIT THAT YOU ARE UNABLE TO RATIONALIZE ANY CRITIQUE ON YOUR BELOVED CHIROQUACKERY

  • …and we have not even factored in or discussed the very real possibility of the so called necessary Chiropractic manipulation or “treatment” causing further harm or injury.
    Glad to see these nonsensical billing infractions and abuse of the health care system being challenged.

  • I have written many reports on patients claiming for ‘whiplash’.
    A few weeks physiotherapy helps them overcome the emotion of the injury and use their
    neck better.

    Why would anyone want to manipulate an injured neck?
    It’s already been subjected to serious forces the like of which it hopefully will not experience again.

    There are no ‘subluxations’ which will benefit from ‘manipulation’.
    There are dislocations which might benefit from surgical reduction and stabilisation.
    Any even partial dislocation needs the patient relaxed with a GA and probably bone levers to reduce the dislocation.
    (Which I have done.)

    I have had a couple of complainants/claimants who have seen a chiropractor. Both had psychological issues and told me they benefitted from the kind attention of the chiropractor.
    Fine – but a chiropractor is not needed for attending professionals to be ‘kind and supportive’.

    If folks want their ‘innate intelligence’ released, so be it – but patients have no idea what chiropract purports to do.
    And do not give informed consent.
    Sigh.

    • RR: And do not give informed consent.

      Ninety-three percent said they always discuss minor risk with their patients.

      Journal of Manipulative and Physiological Therapeutics. Volume 28, Issue 1, January 2005, Pages 15-24

      • DC: But do they tell patients that the scientific consensus is that there are no ‘subluxations’ that need adjusting, and that Parker was wrong in his understanding of spinal morphology, anatomy and pathology?

        And indeed, tried to found a religion on his beliefs – to rival Christian Science. He gave up on this of course – his greatest act of wisdom.

        Thought not.

        And I ask again – why do folks train to be chiropractors and not physiotherapists, osteopaths, or doctors (MD)?
        Do chiropractors explain that?

        Informed consent is not informed if there is no full information.

        • The religious aspect was a legal defense. Baker found it successful and Palmer used it.

          Most chiropractors have moved past the Palmer’s original definition/s of subluxation so it makes no sense for them to include it in an informed consent anymore than a MD would regarding humoralism.

          • DC says: “Most chiropractors have moved past the Palmer’s original definition/s of subluxation”

            Evidence please!

          • RD, start here.

            “ Finally, the IAF report estimated about 10–15% of chiropractors fit into a vertebral subluxation focused subgroup. The results of this present study also show a slightly higher than estimated membership to this subgroup at 21% of respondents.”

            https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07081-0#Fig4

          • @DC

            That is a well-done study: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07081-0, but it has a huge caveat. Over 60% of the people who received the survey did not respond introducing a response bias which the authors address thusly:

            The findings may have been impacted by response bias with a total 39.4% response rate. The response rate might have been improved with use of an incentive. This survey probed topics which may be considered controversial or highly emotionally driven within the chiropractic field. There is potential for resulting social desirability bias and a need to further explore these themes in greater depth.

            While reading thru the paper, following caught my eye:

            Palmer College of Chiropractic – Iowa (20.8%) and Life University (12.0%) were the two most highly reported chiropractic programs attended among respondents.

            In relation to your comment “Most chiropractors have moved past the Palmer’s original definition/s of subluxation…” I wanted to see if the DC programs at the above listed colleges have moved past the Palmer’s original definition of subluxation. However, I am surprised to find that they have not.

            Here are the most recent curriculums for DC programs taught at those schools and a sampling how the program is taught.

            Palmer College of Chiropractic: https://www.palmer.edu/wp-content/uploads/2021/12/palmer-catalog.pdf

            The term “subluxation” appears 49 times in this document. Here is a sampling of statements and course description where the word “subluxation” appears:

            Health is a state of optimal physical, emotional and social well-being. Central to the philosophy of chiropractic is the principle that life is intelligent. This innate intelligence strives to maintain a state of health through adaptation mechanisms. The nervous system is recognized as an avenue for these self-regulating processes. Interference with neurological function can impede these mechanisms, disrupt homeostatic balance and adversely impact health. Chiropractic posits that subluxation of the spinal column and other articulations can affect nervous system function and the expression of health, which may result in symptoms, infirmity and disease. The understanding of the subluxation complex continues to progress from D.D. Palmer’s early writings about misalignment of vertebrae and other articulating structures to include additional anatomical, physiological, biomechanical, chemical and biopsychosocial factors.

            Palmer College embraces the philosophy that life is intelligent and that the human body possesses an inherent potential to maintain itself in a natural state of homeostasis through its innate/inborn intelligence. Moreover, the science of chiropractic emphasizes the relationship between structure and function, primarily that between the spinal column and the nervous system. Implicit within this statement is the significance of the nervous system to health and the effect of the subluxation complex upon the nervous system and, therefore, the body.

            The competent Palmer graduate demonstrates fundamental understanding of anatomy and physiology and synthesizes basic science knowledge to explain health-related issues. The graduate explains current concepts in subluxation theory and models and conceptually interprets pathophysiology using current scientific understanding.

            REHB72856 Physiotherapy II: Active Care Credit Hours: 2 Contact Hours: 3 lecture and 1 lab hour per week Prerequisite: None Prerequisite for: CLIN82831 This course will provide the chiropractic student with fundamental knowledge and skill, which will enable the student to make basic decisions about prescribing and using therapeutic exercise and rehabilitation to restore or enhance function, improve physical skills, prevent re-injury, correct and prevent subluxation, and promote wellness and active lifestyles. It will address the relationship between subluxation and exercise. Using fundamentals developed in earlier trimesters, the focus will be on prescription, development and progression of rehabilitation and exercise programs that will address the conditions most commonly seen in the general practice of chiropractic. An overview of outcome measures will also be included.

            TECH61609 Subluxation Analysis Credit Hours: 2 Contact Hours: 1 lecture hour and 3 lab hours per week Prerequisite: TECH52603 Prerequisite for: All remaining technique courses, DIAG62224 This course lays the foundation of the spinal subluxation evaluation as presented in the technique and clinic curriculum with emphasis on thermographic instrumentation. The components and related assessment procedures of the vertebral subluxation complex will be presented in a stepwise process with an emphasis on integration of clinical findings. These clinical findings will also be related to clinical guidelines relative to the PART system.

            A special emphasis is placed on the study of the spine including anatomy, embryology, histology, neurology, biomechanics and biochemistry, as well as developing skills in the chiropractic analysis of the spine for subluxation and understanding the Palmer Package of chiropractic care.

            CARE53132 Upper Cervical Technique Credit Hours: 3 Contact Hours: 1 lecture and 5 lab hours per week Prerequisites: STRU52124 Prerequisite for: CARE62221 Chiropractic analysis of upper cervical spine subluxation, soft tissue structure palpation and psychomotor skill development including intermediate Palmer Package adjusting skills for the upper cervical spine will be accomplished. Palmer Upper Cervical Specific techniques will be studied. Radiographic signs and mensuration associated with the Palmer Upper Cervical Specific technique will be introduced. Students will demonstrate basic competency in adjustive procedures for the upper cervical spine.

            CARE61212 Lumbar Spine and Pelvic Technique Credit Hours: 4 Contact Hours: 2 lecture and 5 lab hours per week Prerequisites: All first quarter courses Prerequisite for: CARE62221 Chiropractic analysis of spinal and pelvic subluxation, palpation and Palmer Package adjusting skills will be accomplished with an emphasis on the lumbar spine and pelvis. Radiographic signs and mensuration associated with the lumbar spine and pelvis will be introduced.

            CARE62221 Subluxation Analysis and Full Spine Adjusting Credit Hours: 4 Contact Hours: 2 lecture, 4 lab and 2 clinic hours per week Prerequisites: All first and second quarter courses, CARE53132, CARE61212 Prerequisite for: CARE71311 This course provides comprehensive review of chiropractic analysis of spinal subluxation, including inspection, palpation, skin temperature analysis, leg length analysis and radiographic analysis inclusive of the full spine utilizing the Palmer Package. Students will learn intermediate full-spine adjusting skills. Experiential learning will include the opportunity for students to adjust in a laboratory setting under close, direct supervision for the purpose of skill development. In addition, a venipuncture module will be taught during this course.

            Life University: https://www.life.edu/academic-pages/chiropractic-program/chiropractic-curriculum/

            The term “subluxation” appears 24 times in this document. Here is a sampling of course description where the word “subluxation” appears:

            Introduction to Philosophy, Science and Art of Chiropractic: This introductory course will expose first quarter chiropractic students to the discipline of chiropractic, its various philosophic, scientific and artistic components, and their relationship to each other and to patient care. It will also introduce students to the metaphysical and epistemological bases for Chiropractic’s separate and distinct health care approach, as well as its focus on the neuro-spinal dis-relationship embodied in the vertebral subluxation.

            Vaso-Thermal Instrumentation: This course introduces the student to the proper utilization of instrumentation for determining areas of possible subluxation. Several types of instrumentation including infrared and thermocouple devices and their interpretation will be presented.

            Special Senses Diagnosis: This course provides students with an in-depth consideration of the sensory organs, (eyes, ears, nose, and throat) including both normal and abnormal findings as related to the vertebral subluxation complex. The student’s knowledge base incorporates normal and abnormal clinical findings within the realm of special senses, as well as basic dermatological findings that will be illustrated and categorized. Students will demonstrate proficiency in performing examinations of the eyes, ears, nose, and throat. Those conditions most commonly encountered in chiropractic practice are emphasized. The chiropractic management of these conditions will be discussed as they relate to the vertebral subluxation complex.

            To a lay person like myself, it seems like the subluxation theory is methodically hammered into the heads of new graduates of these programs at two of the largest Chiropractic schools in US.

            Give what students are taught in DC programs, the response bias of the study seems much more relevant than before. Therefore, I am not at all convinced that most chiropractors have really moved past Palmer’s legacy.

          • DC: Subluxations are a thing of the past. Most chiros don’t rely on it.

            RD: Why are subluxations a central theme in most of chiro coursework in 2022?

            DC: crickets!

          • RD: DC: Subluxations are a thing of the past. Most chiros don’t rely on it.

            That’s not what I wrote.

            RD: Why are subluxations a central theme in most of chiro coursework in 2022?

            That is what they call what they adjust. PTs, DOs and MDs call it something else.

            DC: crickets!

            Been busy.

          • DC Says:

            That is what they call what they adjust. PTs, DOs and MDs call it something else.

            I call BS and quit defecting. Palmer’s philosophy is still being taught as per the curriculum.

            https://www.palmer.edu/wp-content/uploads/2021/12/palmer-catalog.pdf

            Health is a state of optimal physical, emotional and social well-being. Central to the philosophy of chiropractic is the principle that life is intelligent. This innate intelligence strives to maintain a state of health through adaptation mechanisms. The nervous system is recognized as an avenue for these self-regulating processes. Interference with neurological function can impede these mechanisms, disrupt homeostatic balance and adversely impact health. Chiropractic posits that subluxation of the spinal column and other articulations can affect nervous system function and the expression of health, which may result in symptoms, infirmity and disease. The understanding of the subluxation complex continues to progress from D.D. Palmer’s early writings about misalignment of vertebrae and other articulating structures to include additional anatomical, physiological, biomechanical, chemical and biopsychosocial factors.

            bolding mine.

          • R. Daneel: Why are subluxations a central theme in most of chiro coursework in 2022?

            ‘DC’: That is what they call what they adjust. PTs, DOs and MDs call it something else.

            ‘DC’: Around 20% of chiropractors are “subluxation based”.

            Chiropractic: it’s the money, stupid!

            Blue Wode: I understand that Medicare only pays for manual manipulation of the spine to correct subluxations. Is anyone able to confirm this?

            ‘DC’: Yes, that is true.

            ‘DC’:
            In my area, a few examples:

            Can a PT order imaging? No
            Can a PT do an official reading of imaging? No
            Can a PT do phlebotomy? No
            Can a PT do an official lab report? No
            Can a PT see a Medicare patient without a MD release? No
            Can a PT do HVLA manipulation? No

            Can a DC do all the above? Yes

            [my emphasis]

          • Yes, the first chiropractic college mentions DD Palmers original philosophy.

            “The understanding of the subluxation complex continues to progress from D.D. Palmer’s early writings about misalignment of vertebrae and other articulating structures.”

            Progress: movement to an improved or more developed state (Cambridge)

      • ‘DC’ quoted “Ninety-three percent said they always discuss minor risk with their patients.”

        Consent or Submission? The Practice of Consent within UK Chiropractic
        Journal of Manipulative and Physiological Therapeutics. Volume 28, Issue 1, January 2005, Pages 15-24

        Results
        Of 150 randomly selected chiropractic practitioners in the United Kingdom, 55% responded. Of these, 25% report not informing patients of physical examination procedures prior to commencement. By contrast, only 6% do not fully explain proposed treatment, although over one-third do not advise patients of alternative available treatments. Nearly two-thirds of the practitioners report that there are no specific procedures for which they always obtain written consent and 18% that there are no instances in which they document when verbal consent has been obtained. Ninety-three percent said they always discuss minor risk with their patients but only 23% report always discussing serious risk. When treatment carries a possible risk of a major side-effect only 14% of the sample obtain formal written consent. Documentation of patient understanding is omitted by 75% of practitioners in this sample.

        Conclusion
        Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.

    • Thank you so much for your clear and experienced thoughts on this serious topic. You truly have nailed what is at the root of this ongoing deceptive Chiropractic nonsense.
      If the general public only really knew what was going on here but alas, I suppose there will always those willing to take advantage of the system.
      Kudos to State Farm for finally addressing at least the financial aspect.

      • DN: You truly have nailed what is at the root of this ongoing deceptive Chiropractic nonsense.

        In case you missed it, there are 4 MDs involved in this case.

        • Love Richards observations and comments! Glad to hear there are many other legit Doctors on this site voicing their concerns and sharing important info on this subject matter.

  • I’m not a fan of Chiro, lord knows, but this really isn’t a specific indictment of Chiropractors. I see an equal number of my fellow MDs involved as well.

    Sadly, greed is interprofessional

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