State Farm v. 548912

In State Farm v 548912 filed in 2018, State Farm claimed that a PTP was taking place.  For instance, (a) the initial chiropractic exam used an undefined pain scale of 0-4; (b) the range of motion is not measured or documented in the report; (c) each patient reported the same pain number in their cervical and lumbar; (d) no past medical history is taken; (e) the patient’s height and weight is not taken; (f) when the patients went to the emergency room there was no effort to obtain the records; (g) when the patients had x-rays at the emergency room there was no effort to obtain the films and the doctors subjected the patients to unnecessarily exposure to radiation by taking x-rays in their office after the patient had just received x-rays at the hospital.

The doctors would perform x-rays in their office but refer the interpretation to an outside radiologist.  In some instances, the outside radiologist (a) stated the image quality was not of diagnostic quality and needed to be re-taken but the doctors never re-shot the x-ray; (b) diagnosed a compression fracture but the doctors never referred the patient to an orthopedist and even went forward with performing adjustments to that area of the spine; and (c) diagnosed polyarthropathy and the doctors never referred the patient to a Rheumatologist for follow-up care.

The doctors billed every patient for a 99203 regardless of the severity of their injuries.  They performed neuromuscular re-education without any documentation why and failed to document what exercises the patients performed, the number of repetitions, and how the patient responded to the exercises.  The final reports all said the patient “will require $2,400 in chiropractic care per year” which is highly unlikely for every patient especially if a patient complained of a level 1 pain versus a level 10 pain.