State Farm v. 55443

 In State Farm v 443312 filed in 2020, State Farm claimed that a PTP was taking place.  For instance, (a) the initial chiropractic exam used an

Also, State Farm claimed that a violation of Florida’s Patient Self-Referral Act occurred every time a person called the 1-800 number and was referred to a clinic that was also owned by the same person as the 1-800 number.  The federal judge on this case ruled that no violation of the Patient Self-Referral Act took place because the caller was not “a patient” of the 1-800 number and was merely “a caller.”  In other words, there was nothing wrong with there being two corporations- one for the 1-800 number and another for the clinics- and nothing wrong with the 1-800 number “referring” callers to the clinics, even if they are owned by the same person.

Another issue in the case was “cozy relationships” between the clinics and injury lawyers.  State Farm pointed out that the address listed on sunbiz.org for the referral service is also the address for a digital marketing agency that is owned by the niece of the owner of the referral service.  The website for the digital marketing agency claimed that it “provides services for legal and healthcare companies” and then had 45 videos posted on its Youtube channel for the referral service and a personal injury attorney that has hundreds of clients in common with the clinics.  To further highlight the “cozy relationship” with this law firm, these same lawyers license the 1-800 number in different states and are “sub-licensees” of the 1-800 trademarks in multiple states.

The PTP involves “the overwhelming majority of patients” receiving a positive finding of an EMC by in-house medical doctors and physician assistants.   In the lawsuit State Farm listed this example: patient JEM reported a 1 out of 10 pain in the “back and shoulder…with no numbness, tingling, or weakness…no spasms or tenderness” but the in-house medical doctor wrote down that the patient suffered from an EMC.

The PTP also involved patients “routinely” receiving the same 94941- three to four level spinal manipulation even if they don’t have corresponding complaints.  For example, patient JEM only complained of “back and shoulder” pain, however, received a three to four level spinal adjustment even though JEM only complained about “back and shoulder” pain.  Similarly, patient MA complained of pain in two spinal regions and received the same three to four level spinal adjustment.

The PTP also involves “virtually every patient” complaining about low back pain receiving a Weave 27 or Weave 31 lumbar brace.  The clinic charged $800 and $1,000 respectively but those items could be purchased on Walmart.com for $62.99 or 87.99.

The “Treatment Plan” only listed the frequency (ie “3x week”) and made no effort to describe the passive or active modalities each patient should receive on their next visit, the specific exercises that should be performed, and the areas of the body the modalities should target.

Virtually all patients received at least five modalities with four being passive and the rest being active.  Virtually all patients received hot/cold packs, chiropractic manipulation, manual therapy, electrical stimulation, mechanical traction, neuromuscular reeducation, and therapeutic exercise on each date of service.

Virtually all patients received MRIs even when they had no complaints or minor complaints.

The overwhelming majority of patients were recommended for MRIs on their first visit.

The rationale for the MRI was usually “to rule out herniated nucleus pulposus, herniated discs, or other similar disc injury.”

After the MRIs were performed, the treatment plan did not change.

Final Exams were performed on patients who often received a permanent impairment.  In some cases, patients who reported zero pain, no tenderness, no spasms, and normal ranges of motion still received a permanent impairment rating.

As always, if the medical directors did their job…they would have reported the PTP.