From a press release:
Dr. Thomas Hobbs and Dr. Vivian Carbone-Hobbs of Jefferson County were indicted with two members of their office staff, a former union representative of Anheuser-Busch In Bev, and five patients with conspiring to fraudulently obtain disability benefits from the Social Security Administration...
According to the indictment, the defendants exaggerated the patients’ medical conditions and ability to care for themselves in order to qualify for the government disability benefits and the private insurance disability payments. The chiropractors also required their patients to undergo excessive medical treatments and diagnostic evaluations beyond what was medically necessary to pad their medical records....
Beginning as early as 2011, AB In-Bev employees sought the chiropractors’ assistance because it permitted them to fraudulently obtain Social Security disability insurance benefit payments, a long-term disability insurance payment of $100,000.00 from Prudential Insurance Companies, and long-term and short-term disability benefits through Met-Life. In exchange, his patients paid him as much as $3,000.00 for each of the types of disability payments they were seeking in addition to insurance payments he collected from Blue Cross Blue Shield and United Health Care and payment for unreimbursed services from the patients.
The losses resulting from the false and fraudulent statements to the Social Security Administration and the private insurance disability providers exceeded $12,000,000. ...
Since when does SSA give any weight to the opinion of a chiropractor in a disability claim?
ReplyDeleteAt 9:06
ReplyDeleteNo kidding! Most if not all of these people had to have a valid claim in spite of the chiropractor records. I'd like to see a truly independent review of the claims and see how many of these people meet the criteria if the chiropractor records are ignored. Then let's the true value of the "losses."
Above you see the mentality of the blog. Automatically the individuals are disabled. Automatically, without any evidence whatsoever, not even a mention of conditions, age or education. I would be interested to know if they were represented in the disability cases and if the representatives were in on the fraud too. LTDs almost always have a contract with a DIB mill.
ReplyDeleteGiven that their practice is premised entirely on quackery without any scientific basis, it's appalling to me that anyone would even consider anything a chiropractor has to say when deciding whether to award disability benefits. And given that they cause dozens of strokes every year, many of which turn out to be fatal, it's appalling to me that chiropractors are even permitted to practice their quackery at all.
ReplyDeleteBut money talks, I guess.
An indictment isn't a conviction.
ReplyDelete1. Chiropractor statements are worthless, and they didn't get anyone benefits, unless there were also an ALJ or two involved.
2. The indictment apparently is in part that the chiropractors required their patients to "undergo excessive medical treatments and diagnostic evaluations beyond what was medically necessary to pad their medical records." How is developing a medical record illegal?!?
3. The indictment indicates the accused "exaggerated the patients’ medical conditions and ability to care for themselves..." Rendering a medical opinion is not illegal.
This is absurd.
@ 10:35. I wonder, do you think a lawyer who has been given a designation as "ALJ" knows anymore about a person's medical condition than a chiropractor?
ReplyDelete@10:01
ReplyDeleteNo, the reason people are presuming the recipients are disabled, regardless of the chiropractors' opinion are based on 2 facts.
1, the claims were awarded.
2, chiropractors are not valid medical sources for proffering medical opinions, meaning presumably they were not the basis to establishing disability.
As to the presumption of disability, regardless of conditions, age, or education; yeah in this case the claims were awarded, so those facts are irrelevant. The question is whether the chiropractor's opinions were relevant to the award. As explained above, under the regulations, they aren't, meaning the recipients' claims were validly awarded regardless of the chiropractors' opinions. There is a possibility though, say for example an ALJ or DDS worker(s) were involved, and they ignored the regulations to reach the award, that fraud could have occurred. But that's a way bigger issue than indicated in the indictment notice, and would be speculation.
As to your presumption that "fraud" occurred, what fraud? Proffering medical opinions is just that, a matter of opinion. Absent fabricating clinical findings, I'm not even sure how a crime could have occurred, even if the opinions are absurdly favorable. Even if a treater does NO examination, says the claimant is bed-bound, and terminal, despite their condition being a sprained wrist. That's not fraud, it's just worthless.
@11:53
ReplyDeleteNot necessarily, but that's a fairly ridiculous comparison and defense. ALJs aren't out there maiming and killing their patients to profit from pure unadulterated quackery. Nor does the law permit ALJs to base their decisions upon pure unadulterated quackery, let alone permit them to defraud patients and insurance agencies.
From reading the actual indictment, one of the allegations (not mentioned in the press release) is that Hobbs falsely represented that he was a medical doctor in communication with SSA. So that probably has a good deal to do with both (a) what actual illegal conduct he engaged in and (b) how his opinion was relevant to the disability claim.
ReplyDeleteThis is fascinating! How did two chiropractors get two insurers and the SSA to accept their reports as solid medical evidence? How did they "order" so many tests that would normally require an MD or DO to order, and factor into patients' disablement? So much for thinking I should continue to provide treating physicians' CVs with files! Chuck, keep up the good fight!
ReplyDeleteLTD is big business, that being said, sending an uninsured or under insured claimant for treatment may actually "buy" valuable time. Over the course of time we humans all age. Over the course of time, the claimant's condition usually changes and gets worse. Then, when the claimant presents to a medical doctor, there is an impairment worthy of a favorable decision. TIME IS MONEY.
ReplyDelete@3:25
ReplyDelete11:26/1:21 here.
Thank you. That explains A LOT. Yeah, that would be fraud, assuming the D.C. referred to himself as an M.D. or D.O. Not sure "Dr." would cut it.
Where can I sign up? lol
ReplyDelete@11:53 i think it is about equal to the reps, since so many of them go on to become ALJS. I also think it about equal to the LTD decision makers who do the exact same job for less than the ALJ or a Rep.
ReplyDelete11:53 AM. I am guessing some chiropractors know as much about SOME conditions as doctors do, particularly GPs. I have had doctors that didn't know what Ankylosing Spondylitis was and a Rheumatologist that said, "I don't believe in Fibromyalgia." I have had a doctor, who I was primarily seeing for epilepsy, admit he didn't know much about epilepsy. I have had other doctors tell me, "You only can have one type of seizure." I don't remember the new names, but I have had grand mal, petit mal and psychomotor seizures. I only had 3 of the psychomotor, but had many of the other 2.
ReplyDelete@6:27 AM
ReplyDeleteI'd bet most doctors don't believe fibromyalgia is a real condition. It's not an evidence based diagnosis, after all. And of course there are inept and unknowledgeable doctors out there, and doctors who have no business opining on the issues they opine on. The president's current golden-boy advisor on the coronavirus pandemic (Scott Atlas) is a great example.
But none of that changes the fact that chiropractors are essentially quacks.
@9:01 - do you think there are inept and unknowledgeable ALJs out there pretending they more than doctors? If the medical evidence shows a diagnosis that is a recognized medical condition, how can the ALJ reject it. That kind of arrogance is troubling but I have seen it repeatedly when it comes to fibromyalgia. If you can't put your personal prejudices aside and follow the law, regulations and policies, you need to resign.
ReplyDelete@9:01. You bet the most doctors don't believe fibromyalgia is a real condition would be a loser. I see many good rheumatologist diagnose people with this condition. If you ever met and talked with these folks, you'd know there is something very real going on. It seems to be in the nature of RA or Lupus but the diagnostic tests don't show it. Do you think the doctors are just making this up? Do you think all the people diagnosed with the condition are just making up the symptoms? I know there are ALJs out there who ignore the allegations of the claimant because of this diagnosis. Those ALJs should be recusing themselves from these cases because they are incapable of objectively considering the medical evidence. They think they are smarter than the doctors. I once had an ALJ tell me after a hearing that he didn't think dissociative disorder was a real thing. I don't believe he was a psychologist or psychiatrist. The APA recognizes it as a real disorder, that's all that should matter. Too many of these ALJs think they know more than they actually do about medical conditions and they should not be overruling the opinions of qualified professionals. The courts have called that "playing doctor." The ALJs doing that really need to consider whether they should be in the job.
ReplyDeleteOh, and btw, what about the "quacks" over at DDS. We have one here who has a license that only allows her to work for social security. How is she a qualified medical source? I'd take the opinion of a chiropractor any day over the quacks at DDS that haven't even looked at the records, let alone examined the claimant.
ReplyDelete9:01 AM I think what you mean is, "The tests, medical procedures, etc that could PROVE Fibromyalgia haven't been invented, yet." NO? Clearly SOMETHING is causing the disabling symptoms of Fibromyalgia.
ReplyDeleteAs for the EEG tests used for detecting epilepsy, the tests I took showed nothing out of the ordinary. For nearly ten years, there was NO OBJECTIVE EVIDENCE for a diagnosis of epilepsy or anything else. Nothing unusual on CAT scans, MRIs or ANY other test. Yet, NOBODY suggested the symptoms (seizures) weren't real! Only an EEG with nasopharyngeal electrodes ("sensors" connected by a wire in a plastic tube that go up your nose(one each nostril)) showed any abnormalities, and then only when I dosed off for a few minutes. Only 1 of several regular EEGs taken later showed anything abnormal.