iowa laws and rules review - Palmer College of Chiropractic
Transcription
iowa laws and rules review - Palmer College of Chiropractic
Mary E. Frost, DC PCC Homecoming 2015 IOWA LAWS AND RULES REVIEW 8/12/2015 1 Iowa Laws and Rules: Board Website http://www.idph.state.ia.us/Licensure/Chiropractic.aspx 8/12/2015 2 Iowa Laws and Rules http://www.fclb.org/ 8/12/2015 3 Iowa Laws and Rules http://www.fclb.org/ 8/12/2015 4 Iowa Laws and Rules Where to find information about licensure, laws and rules: – Iowa Department of Professional Licensure • http://www.idph.state.ia.us/Licensure/Chiropractic.aspx • or FCLB.org will take you there with a few clicks • Iowa Board of Chiropractic – – – – – License look up Renewal information CE requirements for new DCs and renewals Laws and rules Disciplinary actions – Also, I have linked to the laws and rules on each slide in this presentation 8/12/2015 5 Iowa Laws and Rules http://www.idph.state.ia.us/Licensure/Chiropractic.aspx?pg=FAQ 8/12/2015 6 Iowa Laws and Rules: FAQ http://www.idph.state.ia.us/Licensure/Chiropractic.aspx?pg=FAQ 8/12/2015 7 Iowa Laws and Rules: FAQ http://www.idph.state.ia.us/Licensure/Chiropractic.aspx?pg=FAQ 8/12/2015 8 Iowa Board of Chiropractic http://www.idph.state.ia.us/Licensure/Chiropractic.aspx Ch. 40 & 151 Duties of the Board: – “…evaluates the qualifications of applicants for licensure and grants licenses to those who qualify” – Develop a policy for continuing education guidelines – “…establishes rules and regulations to ensure the integrity and competence of licensed Chiropractors and investigates complaints for unprofessional conduct” – Discipline 8/12/2015 9 Iowa Board of Chiropractic http://www.idph.state.ia.us/Licensure/Chiropractic.aspx “The Board is the link between the consumer and the licensed Chiropractor, as such, promotes the public health, welfare and safety” 8/12/2015 10 Iowa Board of Chiropractic http://www.idph.state.ia.us/Licensure/Chiropractic.aspx “Licensees are responsible for meeting all licensure requirements and should review the rules carefully and frequently. Select Laws and Rule listed on the left and scroll through the Rules for detailed information about Licensure Definitions, Licensure Renewal, Reactivation and other important content specific to this profession.” Contact Information: (515) 281-4287 8/12/2015 11 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf “Chiropractic” defined: – Persons publicly professing to be chiropractors or publicly professing to assume the duties incident to the practice of chiropractic. – Persons who treat human ailments by the adjustment of the neuromusculoskeletal structures, primarily, by hand or instrument, through spinal care. 8/12/2015 12 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf “Chiropractic” defined: Persons utilizing differential diagnosis and procedures related thereto, withdrawing or ordering withdrawal of the patient’s blood for diagnostic purposes, performing or utilizing routine laboratory tests, performing physical examinations, rendering nutritional advice, utilizing chiropractic physiotherapy procedures, all of which are subject to and authorized by section 151.8. 8/12/2015 13 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf License – Every applicant for a license to practice chiropractic shall do all of the following: 1. Present satisfactory evidence that the applicant possesses a preliminary education equal to the requirements for graduation from an accredited high school or other secondary school. 2. Present a diploma issued by a college of chiropractic approved by the board. 3. Pass an examination prescribed by the board. 8/12/2015 14 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Approved college 1. A college of chiropractic shall not be approved by the board as a college of recognized standing unless the college requires for graduation or for the receipt of any chiropractic degree the completion of a course of study covering a period of four academic years. 8/12/2015 15 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf 2. An approved college of chiropractic may include but is not limited to offerings of courses of study • In procedures for withdrawing a patient’s blood • Performing or utilizing laboratory tests • Performing physical examinations for diagnostic purposes • A chiropractor, employed by an approved college of chiropractic and who has been trained to withdraw blood may withdraw blood and instruct, and supervise a student in the withdrawing of blood. 8/12/2015 16 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Operative surgery — drugs • A license to practice chiropractic shall not authorize the licensee to practice operative surgery or administer or prescribe prescription drugs or controlled substances which can only be prescribed by persons authorized by law Display of word “chiropractor” • Every licensee shall place upon all signs used by the licensee, and display prominently in the licensee’s office the word “chiropractor” 8/12/2015 17 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Training in procedures used in practice 1. A chiropractor shall not use in the chiropractor’s practice the procedures otherwise authorized by law unless the chiropractor has received training in their use by a college of chiropractic offering courses of instructions approved by the board or by curriculum taught on a postgraduate level approved by the board. 8/12/2015 18 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Training in procedures used in practice 2. Any chiropractor licensed as of July 1, 1974, may use the procedures authorized by law if the chiropractor files with the board an affidavit that the chiropractor has completed the necessary training and is fully qualified in these procedures and possesses that degree of proficiency and will exercise that care which is common to physicians in this state. 8/12/2015 19 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Training in procedures used in practice 3. A chiropractor using the additional procedures and practices authorized by this chapter shall be held to the standard of care applicable to any other health care practitioner in this state. 8/12/2015 20 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Revocation or suspension of license A entry to practice as a chiropractor may be revoked or suspended when the licensee is guilty of the following acts or offenses: 1. Fraud in procuring a license 2. Professional incompetency 3. Knowingly making misleading, deceptive, untrue or fraudulent representations in the practice of the licensee’s profession or engaging in unethical conduct or practice harmful or detrimental to the public. Proof of actual injury need not be established 8/12/2015 21 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Revocation or suspension of license 4. Habitual intoxication or addiction to the use of drugs. 5. Conviction of a felony related to the profession or occupation of the licensee or the conviction of any felony that would affect the licensee’s ability to practice as a professional chiropractor. A copy of the record of conviction or plea of guilty shall be conclusive evidence. 8/12/2015 22 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Revocation or suspension of license 6. Fraud in representations as to skill or ability. 7. Use of untruthful or improbable statements in advertisements. 8. Willful or repeated violations of the provisions of this chapter or chapter 272C. 8/12/2015 23 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 24 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 25 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 26 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 27 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 28 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 29 Iowa Laws and Rules: Case Study 1 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 30 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Education requirements – A person who is an applicant for a license to practice chiropractic shall only be required to be tested for the adjunctive procedures specified in section 151.1, subsection 3 which the person chooses to utilize. – A person licensed to practice chiropractic shall only be required to complete continuing education requirements for the adjunctive procedures specified in section 151.1, subsection 3 which the person chooses to utilize. – A person who is an applicant for a license to practice chiropractic or a person licensed to practice chiropractic shall not be required to utilize any of the adjunctive procedures specified in section 151.1, subsection 3 to obtain a license or continue to practice chiropractic, respectively. 8/12/2015 31 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Rules The board shall adopt rules necessary to administer section 151.1 – To protect the health, safety, and welfare of the public, including rules governing the practice of chiropractic and defining any terms, whether or not specified in section 151.1, subsection 3. – Such rules shall not be inconsistent with the practice of chiropractic – Shall not expand the scope of practice of chiropractic or authorize the use of procedures not authorized by this chapter 8/12/2015 32 Iowa Laws and Rules Chapter 151: https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.151.pdf Temporary certificate – The board may, in its discretion, issue a temporary certificate for one year authorizing the certificate holder to practice chiropractic • If, in the opinion of the board, a need exists and the person possesses the qualifications.. • No requirements of the law pertaining to regular permanent licensure are mandatory for the temporary certificate except as specifically designated by the board • The granting of a temporary certificate does not in any way indicate that the person is eligible for regular licensure or that the board is obligated to issue the person a regular license – The fee for the temporary certificate shall be based on the administrative costs of issuing the certificates 8/12/2015 33 Iowa Laws and Rules Chapter 41: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 Chiropractic License • Persons licensed to practice chiropractic shall keep their license publicly displayed in the primary place of practice • Licensees are required to notify the board of chiropractic of changes in residence or place of practice within 30 days after the change of address occurs Do it in writing, make a copy and keep it 8/12/2015 34 Iowa Laws and Rules Chapter 41: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 License Renewal – Iowa issues a chiropractic license for 2 years and expiration occurs June 30 of even-numbered years – So from July 1, 2014- June 30, 2016 is the current biennium New licensees with in this period are required to have 2 hours of Iowa laws and rules in order to renew for the 1st time 8/12/2015 35 Iowa Laws and Rules Chapter 41: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 – For chiropractors who have already renewed their license once in Iowa, only 1 hour of Iowa laws and rules is required • You can still get general CE for the additional hour here today 8/12/2015 36 Iowa Laws and Rules Chapter 41: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 License Renewal – Active license is a license that is current and has not expired – Grace period is the 30-day period following expiration of a license when the license is still considered to be active. In order to renew a license during the grace period, a licensee is required to pay a late fee 8/12/2015 37 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 What is required for renewal? – Board may or may not notify you to renew, it is solely your responsibility to know the law and follow it 8/12/2015 38 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 What is required for renewal? – 60 hours of CE during every 2 year period starting July 1st of even numbered years • at least 36 hours of continuing education credit that directly relates to the clinical case management of chiropractic patients • At least 20 of the 36 hours must be live 8/12/2015 39 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 What does the board consider live? – Beginning with the July 1, 2014- June 30, 2016 renewal cycle, at least 20 of these hours shall be earned by completing program in which an instructor conducts the class employing a traditional, in-person, classroom-type presentation and the licensee is in attendance in the same room as that instructor. 8/12/2015 40 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 So 20 of the 36 hours has to be in the classroom with the instructor- this is a change since the last renewal period What does this mean for me? You can expect proctors to monitor your time carefully while at any CE classes 8/12/2015 41 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 • The remaining 16 hours may be obtained by independent study, including any on-line instruction – So what should you do if you are uncertain about whether hours will count toward the 36 hours of clinical case management of chiropractic patients or 20 hours of in-class, clinical case management of chiropractic patients? • ASK, research and think 8/12/2015 42 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 Other CE requirements – A minimum of two hours per biennium in professional boundaries regarding ethical issues related to professional conduct that may include but are not limited to sexual harassment, sensitivity training and ethics – Two hours of CE credit at the time of the first biennial renewal period and one hour every biennial renewal period after that in the content areas of Iowa Administrative Code 645 -- Chapters 40 through 46 and Iowa Code Chapter 151 8/12/2015 43 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 Other CE requirements – And mandatory training once every 5 years in abuse reporting (child and dependent adult abuse) OR complete a waiver stating why you would be exempt from this training • Training course has to be approved by IDPH – If certified and practicing acupuncture, a minimum of 12 hours of CE must be completed during the biennial period 8/12/2015 44 Iowa Laws and Rules Chapters 41 & 44 : https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=41 https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=44 To renew license- complete renewal application and attestation of completed 60 hours of CE and pay the fee before June 30, 2016 • Can renew online, but do not check the option stating that CE has been completed unless you have completed it 8/12/2015 45 Iowa Laws and Rules: Case Study 2 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 46 Iowa Laws and Rules: Case Study 2 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 47 Iowa Laws and Rules: Case Study 2 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic Case Update: 8. Respondent is hereby CITED for a violation of Iowa Administrative Code rule 43.11 (9) and WARNED that her failure to comply with the laws governing the practice of chiropractic license, including suspension or revocation. 9. Respondent shall provide the Board verification of the completion of the twenty-two hour medical ethics and boundaries course offered at the University of California, Irvine School of Medicine within six (6) months of this O rder. This course is provided by “Professional Boundaries, Inc.” These continuing education hours shall not count toward the Respondent’s continuing education requirement. Respondent is responsible for all costs of the program. Cost for the program: $1875 8/12/2015 48 Iowa Laws and Rules: Case Study 2 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 10. Respondent shall be assessed a civil penalty in the amount of $1000. The civil penalty shall be made payable to the Treasurer of Iowa, mailed to the administrator of the Board, and deposited into the State General Fund. 11. Any failure by Respondent to comply with the terms and conditions of the O rder may subject Respondent to further licensee disciplinary action by the Board. The Settlement Agreement and Final O rder constitute the resolution of a contested case proceeding. 8/12/2015 49 Iowa Laws and Rules: Case Study 2 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 12. Respondent agrees that the State’s counsel may present this Settlement Agreement and Final O rder to the Board ex parte. 13. Respondent understands that this O rder is a public record and is, therefore, subject to inspection and copying by members of the public. 14. This O rder shall be part of Respondent’s permanent record and shall be considered by the Board in determining the nature and severity of any disciplinary action to be imposed in the event of future violations. 8/12/2015 50 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Chiropractic Ethics – 43.2(1) These principles are intended to aid chiropractic physicians individually and collectively in maintaining a high level of ethical conduct. – These are standards by which a chiropractic physician may determine the propriety of the chiropractic physician’s conduct in the chiropractic physician’s relationship with patients, with colleagues, with members of allied professions, and with the public. 8/12/2015 51 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Chiropractic Ethics – The principal objective of the chiropractic profession is to render service to humanity with full respect for the dignity of the person. 43.2(2) – Chiropractic physicians should strive continually to improve chiropractic knowledge and skill, and should make available to their patients and colleagues the benefits of their professional attainments. 43.2(3) 8/12/2015 52 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Chiropractic Ethics – 43.2(3) Chiropractic physicians should strive continually to improve chiropractic knowledge and skill, and should make available to their patients and colleagues the benefits of their professional attainments. – 43.2(4) A chiropractic physician should practice a method of healing founded on a scientific basis, and should not voluntarily associate professionally with anyone who violates this principle. 8/12/2015 53 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Chiropractic Ethics – The chiropractic profession should safeguard the public and itself against chiropractic physicians deficient in moral character or professional competence. Chiropractic physicians should observe all laws, uphold the dignity and honor of the profession and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession. 43.2(5) 8/12/2015 54 Iowa Laws and Rules: Case Study 3 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 55 Iowa Laws and Rules: Case Study 3 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 56 Iowa Laws and Rules: Case Study 3 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8/12/2015 57 Iowa Laws and Rules: Case Study 3 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic Case Update: 5. Respondent has chosen not to contest the allegations in the Statement of Charges and acknowledges that the allegations, if proven in a contested case proceeding, would constitute grounds for the discipline agreed to in this Order. 6. Respondent agrees to VOLUNTARILY SURRENDER his chiropractic license. 8/12/2015 58 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Record keeping – Chiropractic physicians shall maintain clinical records in a manner consistent with the protection of the welfare of the patient – Records shall be timely, dated, chronological, accurate, signed or initialed, legible, and easily understandable – Records should be dated when the note was written or file was amended! 8/12/2015 59 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Utilization Review If your records are reviewed by the Utilization Review Committee (appointed by the board) here is what they are looking for… 8/12/2015 60 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 43.3(4) Types of cases reviewed shall include: a. Utilization. (1) Frequency of treatment; (2) Amount of treatment; (3) Necessity of service; (4) Appropriateness of treatment. b. Usual and customary service. 8/12/2015 61 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 43.3(5) Criteria for review may include but are not limited to: a. Was diagnosis compatible and consistent with information? b. Were X-ray and other examination procedures adequate, or were they insufficient or unrelated to history or diagnosis? c. Were clinical records adequate, complete, and of sufficient frequency? d. Was treatment consistent with diagnosis? e. Was treatment program consistent with scientific knowledge and with academic and clinical training provided in accredited chiropractic colleges? f. Were charges reasonable and customary for the service? 8/12/2015 62 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing Procedures – Chiropractic physicians shall maintain accurate billing records for each patient – Records may be stored on paper or electronically 8/12/2015 63 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing Procedures – The records shall contain all of the following: – – – – – – – – 8/12/2015 Name, date of birth and address Diagnosis indicated with description or ICD code Services provided with description or CPT code Dates of services provided Charges for each service provided Payments made for each service and indication of the party providing payment Dates payments are made Balance due for any outstanding charges 64 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing Procedures 43.11(3) Upon signed request of the patient, the chiropractic physician shall furnish billing records or copies of the records as directed by the patient within 30 days. The chiropractic physician may charge a reasonable fee for duplication of records, but may not refuse to transfer records for nonpayment of any fees. 8/12/2015 65 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing – Chiropractic physicians shall not knowingly: • Increase charges when a patient utilizes a third-party payment program • Report incorrect dates or types of service on any billing documents • Submit charges for services not rendered • Submit charges for services rendered which are not documented in a patient’s record 8/12/2015 66 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing – 43.11(4) Each chiropractic physician is responsible for the accuracy and validity of billings submitted under the chiropractic physician’s name. 8/12/2015 67 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 Billing – 43.11(6) A chiropractic physician has a right to review and correct all billings submitted under the chiropractic physician’s name or identifying number(s). Signature stamps or electronically generated signatures shall be utilized only with the authorization of the chiropractic physician whose name or signature is designated. Such authorization may be revoked at any time in writing by the chiropractic physician. 8/12/2015 68 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 • Billing (con’t.) – Chiropractic physicians shall not knowingly: • Bill patients or make claims under a third-party payer contract for chiropractic services that have not been performed • Bill patients or make claims under a third-party payer contract in a manner which misrepresents the nature of the chiropractic services that have been performed 8/12/2015 69 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic D. FACTUAL CIRCUMSTANCES 1. Respondent is a licensed chiropractor in the State of Iowa. 2. On March 26, 2012, Respondent notified the Board of a federal investigation of her clinics, which Respondent claimed was completed and determined to be unfounded. 3. On April 24, 2012, the Board requested a copy of the final decision in the federal investigation along with a letter of explanation providing the details of what the investigation entailed within fourteen days. 4. On May 14, 2012, Respondent provided a letter but did not provide a copy of the final decision. 8/12/2015 70 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 5. After an additional request from the Board, Respondent submitted an unsigned copy of her Agreement for Pretrial Diversion with the United States Attorney. 6. The Board thereafter requested a signed copy and additional narrative. 7. Respondent never complied with these requests. The Respondent additionally failed to disclose an Addendum to Agreement for Pretrial Diversion, which was executed on June 19, 2012. 8/12/2015 71 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 8. The Agreement for Pretrial Diversion was the culmination in the federal investigation of Respondent's billing practices. As part of the Agreement, Respondent agreed to pay $16,490.54 to the United States and the State of Iowa as restitution for economic losses to the Iowa Medicaid program and $21,981.17 to Wellmark Blue Cross Blue Shield of Iowa for economic losses. 9. The federal investigation revealed that on numerous occasions, Respondents billed for services not provided to patients. For example, Respondent billed for mechanical traction when Respondent's clinic did not have a mechanical traction table. 8/12/2015 72 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 10. The federal investigation revealed that on numerous occasions, Respondent billed Medicaid for services or conditions not covered by the program. 11. The federal investigation revealed that on numerous occasions, Respondent documented patient complaints that were inconsistent with patient's oral complaints. 12. On August 2, 2014, Respondent entered into an agreement with the Iowa Department of Human Services, Iowa Medicaid Enterprise suspending her participation in the Iowa Medicaid program for twenty-five years. 8/12/2015 73 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic C. STATUTES AND RULES INVOLVED Count I Respondent is charged with engaging in unethical conduct or practice harmful or detrimental to the public in violation of Iowa Code section 147.55(3) and Iowa Administrative Code rule 645—45.2(3). Count II Respondent is charged with making misleading, deceptive, untrue or fraudulent representations in the practice of the profession in violation of Iowa Code section 147.55(3) and Iowa Administrative Code rule 645—45.2(3). Count III Respondent is charged with acceptance of any fee by fraud or misrepresentation in violation of Iowa Code 147.55(9) and Iowa Administrative Code rule 645—45.2(9). 8/12/2015 74 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic Count IV Respondent is charged with violation of a law or regulation of this state, namely Iowa Administrative Code rule 645—43.11(7), in violation of Iowa Code section 147.55(9) and Iowa Administrative Code rule 45.2(12). Count V Respondent is charged with violation of a law or regulation of this state as demonstrated by her settlement agreement with the Iowa Department of Human Services in violation Iowa Code section 147.55(9) and Iowa Administrative Code rule 645-45.2(12). Count VI Respondent is charged with failing to cooperate with a board investigation in violation of Iowa Code section 147.55(9) and Iowa Administrative Code rule 645-45-2(i8). 8/12/2015 75 Iowa Laws and Rules: Case Study 4 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic This case is scheduled for a hearing before the board 8/12/2015 76 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 • Chiropractic Assistants – Effective July 1, 2009 • The supervising chiropractic physician shall ensure that a chiropractic assistant has completed a chiropractic assistant training program • A chiropractic assistant training program shall include training and instruction on the use of chiropractic physiotherapy procedures related to services to be provided by the chiropractic assistant • Any chiropractic assistant training program shall be provided by an approved CCE-accredited chiropractic college or a chiropractic state association. 8/12/2015 77 Iowa Laws and Rules Chapter 43: https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=43 • Chiropractic Assistants – Effective July 1, 2009 • A chiropractic physician shall not delegate to the chiropractic assistant the following: 1. Services outside the chiropractic physician’s scope of practice 2. Initiation, alteration, or termination of chiropractic treatment programs 3. Chiropractic manipulation and adjustments 4. Diagnosis of a condition 8/12/2015 78 Iowa Laws and Rules https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=45&pubDate=07-22-2015 Discipline Methods 1. Revocation of license 2. Suspension of license until further order of the board or for a specific period 3. Prohibit permanently, until further order of the board, or for a specific period the licensee’s engaging in specified procedures, methods, or acts 8/12/2015 79 Iowa Laws and Rules https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=45&pubDate=07-22-2015 Discipline Methods 4. Probation 5. Require additional education or training 6. Require a re-examination (board) 7. Order a physical or mental evaluation, or order alcohol and drug screening within a time specified by the board 8/12/2015 80 Iowa Laws and Rules https://www.legis.iowa.gov/law/administrativeRules/rules?agency=645&chapter=45&pubDate=07-22-2015 Discipline Methods 8. Impose civil penalties not to exceed $1000 9. Issue a citation and warning 10. Such other sanctions allowed by law as may be appropriate 8/12/2015 81 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic D. FACTUAL CIRCUMSTANCES 1. Respondent offered employees free chiropractic services as a benefit of employment. If the employee had health insurance that covered the services, Respondent would bill the insurance company but would not charge the employee the required copayment. 2. Respondent reused stimulation pads on multiple patients without properly sanitizing the pads. 3. Respondent discussed a patient’s HIV status at a local bar with two of his employees. The conversation was overheard by others. 4. Respondent employed unlicensed individuals to perform massage therapy services. 8/12/2015 82 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic C. STATUTES AND RULES INVOLVED Count I Respondent is charged with acceptance of any fee by fraud or misrepresentation in violation of Iowa Code section 147.55(8), (9), and 645 Iowa Administrative Code rule 45.2(9). Count II Respondent is charged with negligence in the practice of the profession in violation of Iowa Code section 147.55(9) and 645 Iowa Administrative Code rule 45.2(10). 8/12/2015 83 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic Count III Respondent is charged with violation of a regulation or law of this state, another state, or the United States, which relates to the practice of the profession, in violation of Iowa Code section 147.55(9) and 645 Iowa Administrative Code rule 45.2(12). Count IV Respondent is charged with betrayal of a professional confidence in violation of Iowa Code section 147.55(9) and 645 Iowa Administrative Code Rule 45.2(28)(c). Count V Respondent is charged with permitting an unlicensed employee or person under the licensee’s control to perform activities requiring a license in violation of Iowa Code section 147.55(9) and 645 Iowa Administrative Code rule 45.2(27). 8/12/2015 84 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 7. Respondent understands that this Order is a public record and is, therefore, subject to inspection and copying by members of the public. 8. This Order shall be part of Respondent’s permanent record and shall be considered by the Board in determining the nature and severity of any disciplinary action to be imposed in the event of future violations. 9. This Settlement Agreement and Final Order is subject to approval of the Board. If the Board fails to approve this Settlement Agreement and Final Order, it shall be of no force or effect to either party. 8/12/2015 85 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 10. Respondent admits to Counts II, III, and V as set forth in the Notice of Hearing and Statement of Charges. Respondent admits to the factual allegations set forth in the Notice of Hearing and Statement of Charges with the following revision to paragraph D(3)—Respondent discussed confidential information with his employees at an office meeting at a local restaurant/bar. 8/12/2015 86 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 11. Respondent is hereby CITED for billing insurance companies without collecting the required copayment in connection with the treatment of employees, for reusing equipment on multiple patients that was not properly sanitized, for discussing confidential information in public, employing unlicensed individuals to perform services that require a license and WARNED that his failure to comply with the laws governing the practice of chiropractic in Iowa could result in further discipline against his Iowa chiropractic license, including suspension or revocation. 8/12/2015 87 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 12. Respondent shall be assessed a civil penalty in the amount of $1000. The civil penalty shall be paid within thirty days from the date this agreement is accepted by the Board. The civil penalty shall be made payable to the Treasurer of Iowa, mailed to the administrator of the Board, and deposited into the State General Fund. 8/12/2015 88 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 13. Respondent shall provide the Board verification of the completion of 20 hours of continuing education meeting the standards set forth in 645 Iowa Administrative Code chapter 44 in the areas of HIPAA and billing practices within one year from the date this agreement is accepted by the Board. These hours shall not count toward Respondent’s continuing education renewal requirements. Respondent is responsible for all costs associated with the continuing education. 8/12/2015 89 Iowa Laws and Rules: Case Study 5 http://www.idph.state.ia.us/Licensure/Actions.aspx?board=Chiropractic 14. Any failure by Respondent to comply with the terms and conditions of this Order may subject Respondent to further licensee disciplinary action by the Board. 15. The Board’s approval of this Settlement Agreement and Final Order shall constitute a FINAL ORDER of The Board. 8/12/2015 90 Thank you for your attention 8/12/2015 91