It never fails! At every college or convention I speak at, I always get the same infamous questions about seminars. The doctors and students want to know which ones are good, which are the best, if attending certain seminars is really a problem, are they legal, etc. Well, here are some things to consider. This article does not point any fingers at any specific consulting companies conducting seminars, but it does point out the issues and challenges that are increasingly developing in the seminar world.
My intent is not to disparage any specific seminar, but to focus on aspects that may not be readily apparent. Additionally, to be forewarned is to be forearmed, so this information is a cautionary warning to doctors or students thinking about attending these kinds of seminars. It is important that we all understand those individuals whose job it is to regulate and monitor the activities of various professionals. It is also interesting and helpful to know what programs these investigators are attending, since they are usually designed to maximize the doctor's financial well-being, irrespective of how cleverly the seminar title is couched.
There are seminars touting license renewal credits, practice management programs, personal coaching, tips on practice-building, HIPAA compliance programs, Medicare workshops, how to build a million-dollar practice, the benefits of integrated practices, how to run a cash practice, establish a credit card practice, incorporate a new case fee practice, create a designer consigner practice - the list is endless. One only has to look at chiropractic publications or log on to the Internet to appreciate the hodge-podge of promises and marketing hype that is out there.
Want to know a little secret? Doctors wanting to "boost" their practices are not the only ones reading these advertisements with interest. The U.S. General Accounting Office (GAO), for example, recently issued a report of its investigation of health care consultants. That investigation included a clandestine surveillance and taping of seminars and workshops. The GAO hired a physician "spy" who attended two workshops and a seminar, accompanied by a criminal investigator posing as a member of her staff. They decided which programs to target based on whether they advertised "how to enhance revenue and avoid audit."
The two programs they attended were titled: "How to Run a More Profitable Practice" and "Creating a 7-Step Compliance Plan Audit/Audit-Proof Your Practice."
Do these have a familiar ring to them? Now, bear in mind that these programs were not put on by any "Johnny-come-lately," fly-by-night opportunists. The same consulting company presented both workshops and claims to have had more than 50,000 physicians and 100,000 office managers and medical assistants attend its programs over the years. One of the workshops was even sponsored by the Medical Society of the District of Columbia, and the second qualified for continuing education credits under the auspices of the American Association of Medical Assistants.
The GAO Report
The investigators reported that billing practices, as recommended by the consultants, could invite investigations (The full report may be found on the Web at www.gao.gov: GAO-01-818). It isn't pretty reading. The advice the seminars provided was supposedly "inconsistent with guidance provided by the Department of Health and Human Service's' Office of Inspector General (OIG). Such advice could result in violations of both civil and criminal statutes."
The report was particularly critical concerning the following:
Moreover, when specifically asked the proper course of action to take if an "overpayment" is discovered, the consultant responded (again appropriately) that providers are required to report and refund overpayments. He then reportedly added, however, that instead of refunding overpayments, physician practices generally fix problems in their billing systems that cause overpayments while "keeping their mouths shut" and "getting on with life." While that observation is almost certainly true and accurate, the reporters and attendees probably all inferred that it was offered to encourage attendees to employ that same strategy themselves, rather than risking inviting an audit. All the right words were said about the proper course of action to take, but during the discussion, one could easily observe that the intent of the information was really designed to let doctors know they could "get around the issue" by fixing the problem and keeping their mouth shut. What kind of message is that sending? Well, it did not go unnoticed.
Attendees of many chiropractic programs and "clients" of any number of chiropractic consultants may be scratching their heads at this point, asking: "What's the big deal? That's nothing compared to some of the things I've been told to do."
Doctors are well-advised to keep in mind the pithy old saying, "You're not paranoid if everyone really is out to get you." The conclusion of the GAO report mentions somewhat too casually:
"We have discussed with the Department of Health and Human Service's OIG the need to monitor workshops and seminars similar to the ones we attended."
If the OIG follows that recommendation, and follows the same selection protocol used by the investigators doing the report (whether a particular seminar "advertised how to enhance revenue and avoid audit"), how do chiropractic seminars stack up? A quick surf of the Web yielded the following sadly representative offerings:
So, What Should I Do?
I know there will be some out there who will take exception to this article. My purpose is not to identify those who are teaching processes and procedures that may be suspect on close observation, or even illegal in the worst-case scenario. One only has to read any of our chiropractic publications in the past year to see headline articles about management consultants who have been fined, arrested, jailed or are under investigation (for example, see the top story in Dynamic Chiropractic, Oct. 21, 2004).
If you have nothing to worry about - then don't worry! But on the other hand, if you have attended some seminars and your "visceral reaction" causes you to be uncomfortable, I suggest you listen to your gut. There are certainly good consultants and good seminars being taught in an honest, ethical and legal fashion, but unfortunately, doctors of chiropractic have fallen prey (for some reason) to those who are hell-bent on exploitation of the individual, and thus the profession.
To those who are good, I say that you will survive the test imposed by the attendees. To those who cannot pass the test, I hope you are exposed for the unscrupulous practices you promote, enabling the profession to rid itself of activities that give us a collective black eye.
So, caveat emptor - and not only should the buyer beware, but those who are selling should also know that Big Brother may really be watching.
Louis Sportelli, DC
Palmerton, Pennsylvania
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