State Farm v. 8972031
In State Farm v. 8972031 filed in 2022, State Farm claimed there was an issue with ultrasound therapy. Ultrasound therapy is used to decrease inflammation and pain during the acute stage of care. In this case, State Farm claimed that the clinic was billing 97035 (supervised one-on-one ultrasound therapy) when they were really performing 97039 (unsupervised ultrasound therapy) because the supervised code paid about twice as much money.
State Farm claimed that the clinic added the word “supervised” on the CMS-1500 form; the notes for the visit didn’t specify if it was supervised or not; and, in a deposition of the doctor-owner, stated under oath that the treatment was “supervised” but that the RCA/Chiropractor would leave the room for periods of time during the time that the ultrasound therapy was being performed (i.e., not supervised).
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company, therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.