The New York Chiropractic Council (COUNCIL) and the New York State Chiropractic Association (NYSCA) have been in UNITY discussions for a number of years. The purpose of which is to form a new organization called the Chiropractic Society of the State of New York (CSSNY).
Much work has been done by each organization toward this end by each of the respective committees and subcommittees, involved in this process.
The issues that stand before us are significant ones. Each organization has its perspective and understanding of the process, but must be cognizant of the fiduciary responsibility to each organizations current respective members. The Council is faced with a stalemate in moving the process forward based on the following issues.
The first of these issues is the requirement sought by NYSCA to maintain and carry forward into the new organization, Affiliation of the American Chiropractic Association with full voting privileges. As a matter of notice to the reader this specific part of the UNITY document is contentious since the language the NYSCA wants to use is, “any bona fide trade organization that seeks membership and is approved can be granted full voting rights in the Society” (CSSNY).
We, the COUNCIL, have agreed to affiliation without voting rights of a bona fide Chiropractic trade organization and have been rebuffed at every turn and meeting with the NYSCA.
We cannot in good conscience or without sound justification agree to voting rights being granted to an outside agency regardless of the standing that organization has in Chiropractic.
The other issue we have attempted to find common ground on is the concept of one person one vote and district representation.
This would result in too large of a board within the CSSNY. A board of this size will increase cost of staff and communications as well as prevent the board from meeting often enough to be productive. Many organizational experts have commented on how this often results in a core group of individuals who have greater say and control over the organization with everyone else being delegated to an advisory type position.
This obviously would not be appropriate if the two organizations are serious about moving the profession forward and allowing for equal opportunity by considering all opinions for those in board positions and within membership. Creating a concentration of power among a few individuals is incongruent with a successful organization as it reduces chances for change and discourages future leadership.
All recommendations reviewed found that the board should be no bigger than needed. The board should be representative of the organizational size based on members with the caveat that boards larger than 18 people tend to be ineffective. The one person one vote perspective has been tried by many different organizational groups and countries.
The only time, a one person one vote is possible, is with a full member vote. This is usually reserved for organizational decisions of a certain magnitude and is something the COUNCIL has done when needed. We see the new organization as involving our entire membership when decisions such as organizational structure and or organizational commitments are involved.
So as you can see there are two committee level issues that need to be handled, that are not easily surmountable since the organizational perspectives are askance.
The organizational issue at question and in hand is NYS SCOPE MODERNIZATION pushed by NYSCA and other groups/ institutions within NYS Chiropractic. A clear Identity of our profession is necessary. We, the Council, define the primary role of a chiropractor just as our defining law is currently written. The current “modern” language is Vertebral Subluxation and is understood to have many components of which muscle and bone are just 2 components. The primary duty of chiropractic is our current state law, even though some chiropractors may do other non-primary duties.
All of the above is with regard to a call to UNITE chiropractic under an umbrella with room for all. It is our hope that the umbrella is a metaphor which brings us together under our one great profession, while allowing us to practice as we choose within the law. This is the core of unity as a process. We are uniting to represent NY Chiropractors practicing in NYS. Unity is about realizing that we have more in common than we are different. It is not about making everyone the same. The CSSNY must be able to represent the majority of chiropractors in the state of New York.
Other outside organizations will not fulfill this job description. This is pertinent to the suggested change in scope, something the COUNCIL has reviewed and reserved public comment since that document we reviewed was not finalized. We appreciate that the NYSCA has been open in private and public meetings about what they would like.
The NYSCA has detailed specifically the following changes in scope of practice:
• Extremity adjusting (without the necessity of relating it back to the spine).
• Nutritional consultation and supplementation.
Examination for diagnosis, differential diagnosis, school/camp/sports physicals, scoliosis screening and DOT examination.
• Stand-alone diagnostic services (Electro diagnosis, musculoskeletal ultrasound)
The way this is being suggested by the NYSCA is to update and modernize our scope. The very idea being we need to have a scope that represents what is taught in the schools. This is consistent with the path historically taken by the Osteopaths as detailed by Norman Gevitz in his book The DO’s in America. He described the change that the Osteopaths took to become physicians equal to MD’s.
The NY Chiropractic Council recognizes that Chiropractic is an incredible, distinct approach to healthcare as defined by our philosophically identified niche in healthcare. Our current New York State law governing scope of practice is written as:
The practice of the profession of chiropractic is defined as detecting and correcting by manual or mechanical means structural imbalance, distortion, or subluxations in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column.
The key phrase contained above is not subluxation alone but rather subluxation with resultant nerve interference and the effects thereof. The law was written to be broad scope based on this language. Some trends within our profession in NYS and across the country reveal a systematic move away from this interpretation. Much of the direction and decision making is based solely on the treatment of musculoskeletal conditions related to the subluxation. The Council remains open to new dialogue with respect to scope update, but be assured, we are committed to protecting our right to maintain our ability to detect and correct vertebral subluxation and to continue to advance our unique science, art and philosophy as it relates to human health. This is an affirmation of Chiropractic as a separate and distinct approach to healthcare with a different philosophical understanding to the cause of health.
The move to expand scope appears to be motivated by economic reasons with a focus on increasing our ability to bill for additional services outside of the spinal adjustment. Although this would be financially beneficial to the profession, the Council remains unconvinced that the Insurance industry will increase policy service benefits and incur additional financial responsibilities. This approach when attempted previously was met with the stance that the services might be unnecessary as they are presumed to be a duplication of services already performed by other healthcare providers within their provider networks.
We disagree with the philosophy that, if a college teaches it we should be allowed to do it. The reason for this is that much of the curriculum taught in our chiropractic colleges are not part of the minimum CCE requirements and do not have to be approved by the CCE. This leaves a huge gap in what can be taught, and should not automatically be included in our scope, i.e.: drugs, surgery, and gynecology. We also disagree with the logic in the following thought; if it is stated specifically in our scope then the Insurance industry will have to pay for it. Just because something is in our scope, does not guarantee insurance reimbursement.
It is clear that many people are invested in changing Chiropractic into something different than it has stood for many years. The irony is that chiropractic was clearly defined when they chose to enter school to become part of the profession. The question begs the answer as to why one would want to be a part of something they ultimately want to change? Further consideration should be given to whether those people should be given the opportunity to change the profession? The question is, who should be the guardians of our profession? Should anyone, even those who don't believe in the original premise of our profession, be allowed to change it to better serve their individual needs, wants or thoughts of what chiropractic should look like?
The question the COUNCIL poses to its members is why. As mentioned above, Norman Gevitz an anthropologist who studied the Osteopaths in America, much of what is being suggested is the exact path taken by the Osteopaths over 50 years ago.
The COUNCIL was born out of a disagreement with the NYSCA leadership over 25 years ago. Our current task is to realize that we have more in common than we are different. We are committed to principled agreement and preservation of Chiropractic’s uniqueness as a separate and distinct approach to healthcare and not a reduction to a finite method of treatment. Chiropractic should not be relegated to a poorly supported mediocre and expensive treatment for uncomplicated acute low back pain.
So it is well accepted and understood by all New York Chiropractic Council Members we are in support of unity with open respect and room for all. This was stated by you the membership in May 2007, when a poll was released to all members as to whether you were in favor of the “Council” moving forward with working towards unity.
We cannot agree to an affiliation with voting rights for any outside organization regardless of the relationship we might have with them. The COUNCIL has always welcomed a representative from any organization in Chiropractic as a non-voting position. We are also committed to having a manageable board size that makes the new organization able to respond to and provide for its members. This cannot be possible following the one person one vote rule given the numerical demographic makeup of Chiropractic in NYS.
Scope as suggested above and previously discussed with the NYSCA is precarious and not the panacea for Chiropractic in NY as some have suggested. The COUNCIL Board has stated that we are committed to two ideas, the first being preservation of our subluxation language in any new law written. The other is no prescription rights and no drugs in Chiropractic in NY. These seem to be two foundational ideas we can continue to build on as we move chiropractic forward in the state of New York.
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Please click on the documents to view the proposed CCE standards
CCE Standards 2012 Draft
CCE Standards 2007
N.Y. Chiropractic Council's Response
Court Permits Provider ERISA Class Action to Proceed Against Blue Cross Blue Shield Companies for Improper Overpayment Demands and Forced Recoupment
NEW YORK , May 25, 2010 (GLOBENEWSWIRE) Pomerantz Haudek Grossman & Gross LLP (the "Pomerantz Firm") today announced that the United States District Court for the Northern District of Illinois upheld claims filed under the Employee Retirement Income Security Act of 1974 ("ERISA") against 22 leading Blue Cross Blue Shield ("BCBS") insurers across the country. The action was filed on behalf of a putative nationwide class of health care providers, as well as the Pennsylvania Chiropractic Association ("PCA"), the New York Chiropractic Council (the "Council"), the Association of New Jersey Chiropractors ("ANJC"), the Florida Chiropractic Association ("FCA"), and the California Chiropractic Association ("CCA"). The suit challenges the Defendants' abusive practices in using post-payment audits and reviews, and improper repayment demands, to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers.
The action alleges that BCBS' post-payment audit and review process violates ERISA. Plaintiffs allege that BCBS' repayment demands are retroactive determinations that particular services are not covered under the terms of the BCBS health care plans, but without proper appeal or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. According to Plaintiffs' counsel D. Brian Hufford of the Pomerantz Firm, "this decision is a critical first step in this litigation, as it recognizes the validity of our underlying claims under ERISA and now allows us to proceed to the real work of the case - to obtain the discovery necessary to prove our contention that the various BCBS entities have improperly taken millions of dollars from providers nationwide."
The Court also upheld association plaintiffs' right to pursue injunctive remedies in a representational capacity on behalf of their members. The Court permitted the individual plaintiffs' claims to go forward even though some had settled with BCBS, noting that these plaintiffs had alleged "that they did so under duress because they were not able to effectively appeal due to defendants' improper actions."
Although the court dismissed the claims under the Racketeer Influenced and Corrupt Organizations Act ("RICO"), plaintiffs intend to serve an amended complaint. Co-counsel Vincent Buttaci of Buttaci & Leardi LLC states: "We currently intend to seek leave to replead the RICO allegations. We strongly believe that we have the necessary facts to satisfy the RICO pleading requirements as outlined by the Court."
In another ruling, the Court found that six of the 18 individual plaintiffs had arbitration clauses in their in-network provider agreements, which required them to arbitrate their claims rather than pursue relief through the courts. Similarly, the Court found that that California Chiropractic Association should pursue claims through arbitration, since defendants showed that their standard practice was to use arbitration clauses in California. Significantly, however, the Court concluded that the litigation should not be stayed.
The amount at issue in the lawsuit is substantial. On June 30, 2009, the Blue Cross Blue Shield Association, "a national federation of . . . Blue Cross and Blue Shield companies," announced that its National Anti-Fraud Department had "recovered nearly $350 million as a result of the anti-fraud investigations in 2008." Plaintiffs believe that a significant portion of this "recovery" falls within the improper practices that are being challenged in the lawsuit, and should be repaid to providers. Pomerantz Haudek and Buttaci & Leardi have brought a similar class action challenging improper post-payment audits and repayment demands against Aetna, and are investigating comparable claims against other insurers.
"This is a landmark decision, with widespread implications for the health care industry," says Jin Zhou, D.C. "Providers finally have a means to fight back against insurance companies for making invalid overpayment demands." Dr. Zhou is a national ERISA consultant who, through his website,www.ERISAclaim.com, and consulting services he offers to providers and plan sponsors, has long advocated the use of ERISA to combat improper post-payment audit activities.
The Pomerantz Firm, with offices in New York, Chicago, Washington, D.C., Columbus, Ohio and the San Francisco Bay area, is acknowledged as one of the premier plaintiff class action firms, and, in particular, has been a leader in the industry in health care class actions on behalf of providers and patients. Recently, the Pomerantz Firm was designated to be Chair of the Plaintiffs' Executive Committee in a multidistrict litigation pending against Aetna in the District of New Jersey on behalf of both providers and subscribers, challenging how Aetna determines usual, customary and reasonable ("UCR") rates for out-of-network health care services. In making the appointment, the Court stressed the significant role Pomerantz Haudek had played in a $249 million settlement of its UCR class action against Health Net, stating that the Court had "similarly appointed Pomerantz to be Plaintiffs' spokesman to the Court in the Health Net litigation because the Court found Mr. Hufford to be the attorney most capable of presenting Plaintiffs' position in a clear and concise manner." The Pomerantz Firm has also obtained preliminary approval of a $350 million settlement with United Health Group on similar UCR issues.
Founded by the late Abraham L. Pomerantz, known as the dean of the class action bar, the Pomerantz Firm pioneered the field of securities class actions. Today, more than 70 years later, the Pomerantz Firm continues in the tradition he established, fighting for the rights of victims of fraud, breaches of fiduciary duty, and corporate misconduct. The Firm has recovered numerous multimillion-dollar damages awards on behalf of class members.
Buttaci & Leardi, based in Princeton, New Jersey, has a dynamic national health care practice, representing licensed health care providers, group practices and other provider-related entities throughout the country. It has extensive experience representing providers in challenging post-payment audits and retroactive recoupments, including those pursued by numerous Blue Cross Blue Shield licensees, and has obtained tremendous success on behalf of its clients.
Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (212-661-1100) or email (email@example.com), or Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-799-5150) or email (firstname.lastname@example.org).
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|COUNCIL SUES BC BS FOR ABUSIVE BEHAVIOR
|New York, NY (September 11, 2009) - The NY Chiropractic Council (the "Council") as well as the Pennsylvania Chiropractic Association ("PCA"), the Association of New Jersey Chiropractors ("ANJC"), fourteen individual chiropractors and one occupational therapist, located around the country, have sued as the class representatives of the putative class.
11/06/2009 09:50 AM