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Ohio chiropractors renew commitment to prevent workers’ compensation abuse
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Ohio chiropractors renew commitment to prevent workers’ compensation abuse

Worker's CompCleveland, OHIO -- On June 7, 2011, in Canton, Ohio, the Ohio State Chiropractic Association (OSCA) held a seminar on "Ohio Workers’ Compensation Fraud and Abuse Prevention for Providers.” As continued commitment and dedication under new leadership of OSCA, this full-day seminar was attended by 29 chiropractic physicians and their staff, and members of OSCA Workers’ Compensation (WC) Committee. Primary goals were to increase providers’ awareness of WC fraud and abuse through voluntary compliance and the best strategies to prevent or eliminate any workers’ compensation fraud and abuse.

The seminar included a systematic review on statutory and regulatory, as well as administrative, policies on Ohio workers’ compensation fraud and enforcement. Approved for continued education credit hours for licensing renewal, the seminar was led by Dr. Jin Zhou, DC, president of ERISAclaim.com and national expert on provider appeals and compliance.

"Chiropractic physicians are important partners in the Ohio workers’ compensation system. OSCA has been on the front lines in combating fraud and abuse, and supporting and assisting BWC and the Attorney General in enforcement. Today, OSCA offered this advanced seminar to renew our dedication and commitment on behalf of our profession,” said Dr. Otto J. Schmidt, DC, OSCA president.

In a dynamic presentation utilizing the BWC website, Zhou reviewed the latest news in Ohio workers’ compensation fraud, investigation and enforcement against health care providers and other entities, BWC annual fraud statistics, BWC fraud educational materials, BWC "Fraud Red Flags”–spotting, injured worker claim fraud, health-care provider fraud, employer fraud and MCO fraud—and Ohio policies on fraud and enforcement. The chiropractic physicians from most districts of Ohio participated in the comprehensive, in-depth discussion on the best strategy and practice in workers’ compensation fraud and abuse prevention.

"Proactive education and voluntary compliance have been proven to be most effective for our member physicians. Ongoing support for OSCA members in prevention of fraud and abuse is the best protection from criminal and civil prosecutions," explained Dr. Judson G. Sprandel, II, DC, past president of OSCA and chair of OSCA WC Committee.

"The current fraud investigative and enforcement environment made our antifraud and abuse prevention compliance program more critically important, as an integral part of our membership benefits and practice standards. We will offer this type of education on regular basis for our members,” added Bharon Hoag, OSCA executive director.

A new OSCA Workers’ Compensation mission statement was adopted by OSCA WC Committee:

"It is the official policy of the Ohio State Chiropractic Association (OSCA) WC Committee that a chiropractic physician be encouraged to advocate for medically appropriate chiropractic health care services for his or her patients injured in workplaces. For the purposes of this policy, "to advocate for medically appropriate chiropractic health care services” means to appeal a decision to deny appropriate health care service in compliance with applicable Ohio workers’ compensation and public health laws, in accordance with the standards of chiropractic care, as well as professional ethics, and pursuant to the reasonable grievance or appeal procedure established by the Industrial Commission of Ohio (IC) and the Ohio Bureau of Workers’ Compensation (BWC); or to protest a decision, policy or practice that the chiropractic physician, consistent with that degree of learning and skill ordinarily posed by chiropractic physicians in the same or a similar locality and under similar circumstances reasonably believes impairs the chiropractic physician’s ability to provide appropriate chiropractic health care services to his or her patients injured in workplaces.

The OSCA is against any fraud in violation of any applicable Ohio laws to defraud Ohio workers’ compensation systems, by any person, MCO, employer, company, insurance carrier, employee, healthcare provider, attorney, state entity or other entity engaging in the following acts, including but not limited to:

  1. Intentionally present or cause to be presented any false or fraudulent claim for the payment of any workers’ compensation benefit.
  2. Intentionally making or causing to be made any false or fraudulent material statement or material representation for the purpose of obtaining or denying any workers’ compensation benefit.
  3. Intentionally making or causing to be made any false or fraudulent statement with regard to entitlement to workers’ compensation benefits with the intent to prevent an injured worker from making a legitimate claim for any workers’ compensation benefits.

The OSCA WC Committee is committed to helping Ohio injured workers to obtain their justified covered benefits, and will work toward improving the Ohio BWC system.”

Located in Columbus, Ohio, the OSCA is the leading Chiropractic state association with hundreds of doctor members statewide. OSCA represents its members through advocating and promoting chiropractic science and healthcare services, supporting and protecting its members through compliance assistance in claims educational guidance and appeals, and patient advocacy. OSCA provides accurate information and advice to the state legislators and prospective patients in the state of Ohio.

Information regarding the OSCA fraud and abuse prevention compliance programs and membership benefits can be accessed at www.oscachiro.org or by contacting Executive Director Bharon Hoag at 1-800-837-6721 or (614) 229-5290.

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