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The Dishonest Chiropractor/Physician  

https://zalma.com/blog 

A dishonest physician or chiropractor will, for a fee, prepare  fictitious medical reports, including billings for multiple series of  physical therapy treatments. Sometimes the report of a legitimate  accident victim is modified only in the name, address, and physical  attributes of the victim. In all other respects, the reports are  legitimate. T

hey are not a report of the victim\\u2019s actual injuries since  the victim either did not exist or was not injured. Medical bills  generated by such fiction total between $1200 and $3500. The numbers are  kept small to avoid suspicion and tempt insurers into making a quick  settlement.  When I was a young adjuster I dealt with these scofflaws and paid  fraudulent claims because I, like most young adjusters, was unaware of  the amount of fraud being perpetrated. Within a year I learned and  refused to pay the suspected frauds and advised them that the insurer I  worked for would pay nothing and they should file suit. I was convinced  it was a fraud when the suit was never filed.  

Because of the ease of use a single clerk typist with a word processor  can prepare two hundred medical reports a day with the doctors\\u2019 laser  printer even generating his signature from a scanned image. The doctor,  not involved in the procedure, receives $100 to $500 per report. The  doctor is quite happy with his earnings since he need not see a patient  nor provide treatment.  This type of fraud operation can present hundreds of claims a month on  individuals who were not injured or never injured. The claims can  generate millions of dollars a year in net profits for the lawyers,  physicians and recruiters involved in the crime. By applying the maxims  set forth in the last chapter these insurance criminals discovered that  the person claimed injured, (that is the lawyer\\u2019s alleged client) will  almost never be seen by an adjuster, investigator or independent medical  examiner.  The criminals know that as long as they keep the claims small no lawyer  will be called upon to take testimony from the person identified as  injured. The criminals know that no one will go to the medical clinic to  learn whether they really provided the treatment claimed. Since the  insurance criminals keep their medical treatment down to minimal level  and the demands of the lawyer are always reasonable, the claims settle  quickly. The adjuster\\u2019s supervisors commend the adjuster for closing  files. 

The adjuster is rewarded for keeping expense costs down. The  insurer saved the cost of a lawyer. The fraud was a success.  Occasionally, we read reports about the police or the fraud bureaus  making arrests of a massive fraud ring. The arrests just touch the cream  at the top of the glass of milk. The rest remains. It is greed that  causes the criminal\\u2019s demands to become sufficiently high to cause the  insurer to investigate the claim.  Insurers must realize that savings of expense dollars can, and almost  always will, cost them more in indemnity dollars.  New data base systems allow insurers to obtain records concerning all  claims supported by the crooked chiropractor, lawyer or physician. If  volume is too high the information provided to an insurer from the All  Claims Database, CLUE, or other databases will raise suspicions of fraud  sufficient to compel a thorough fraud investigation.  

\\xa9 2022 \\u2013 Barry Zalma