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Dynamic Chiropractic – November 30, 2004, Vol. 22, Issue 25

Third-Party Payers Investigating UnclePaul

By Editorial Staff
A number of sources have confirmed that private insurance companies are in the process of investigating the UnclePaul corporation. The fact that payers are involved in these investigations introduces the likelihood that UnclePaul offices will have their past billings scrutinized. If these billings are found to be fraudulent or in violation of reimbursement rules, UnclePaul could be responsible for the repayment of potentially millions of dollars. According to Michael Schroeder, an attorney who is a specialist on questions of insurance fraud, "This is common. Prosecutors often work hand-in-hand with private insurance companies with regard to large-scale investigations of potential insurance fraud. In a case of this size, it would be surprising if there was not at least some sharing of information between the prosecutors and the affected insurance companies."

Special investigation units for various third-party payers are in the process of gathering information concerning the billing and treatment practices of the UnclePaul offices. This high-profile case could involve upwards of 100 offices, making the amount of money involved quite large - particularly in cases involving personal injury, in which the liability could exceed the amount reimbursed for care. For this reason, investigators are expected to look at the entire UnclePaul organization, rather than just its training offices.

The initial complaint against UnclePaul was featured in an article in the Sept. 27 issue.1 We reported that Jeffrey Miller, DC, had filed an 18-page complaint with the Kentucky Board of Chiropractic Examiners against UnclePaul and its owner, Dr. Paul Hollern, alleging "multiple violations of Kentucky laws governing the practice of chiropractic." Dr. Miller served as the COO for UnclePaul from Oct. 1, 2003, until Jan. 8, 2004. The complaint alleged numerous violations of state statutes in up to 20 states.2

A follow-up article in the Oct. 21 issue revealed that at least two federal agencies were also involved in investigations of the UnclePaul organization.3 Doctors involved with the UnclePaul Chiropractic Business Training corporation confirmed that they had been contacted by investigators from the U.S. Department of Justice, the U.S. Attorney's Office and the U.S. Department of Health and Human Services' Office of Investigations. According to these sources, federal investigators initially contacted some of them as early as the beginning of May 2004.

More information is likely forthcoming regarding this high-profile case. DC will report further as the situation develops.

References

  1. UnclePaul accused. Dynamic Chiropractic, Sept. 27, 2004: www.chiroweb.com/archives/22/20/14.html.
  2. The entire 18-page complaint appears online at www.chiroweb.com/unclepaul.
  3. Are federal investigators after UnclePaul? Dynamic Chiropractic, Oct. 21, 2004: www.chiroweb.com/archives/22/22/17.html.
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