Arizona Auditor General Releases 2010 Performance Audit and Sunset Review

AGREES WITH ACS THAT BROAD AND OPEN-ENDED CHIROPRACTIC BOARD SUBPOENAS BASED ON EVERY COMPLAINT MUST END

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The Auditor General has condemned broad and open-ended subpoenas issued by the Chiropractic Board in every case, called "fishing expeditions" by ACS. Here is the language from the full report which you can read by clicking here. This issue was brought to the attention of the Auditor General by ACS members who sent in letters in coordination with ACS.

"Investigating complaints—When investigating complaints, the Board generally subpoenas all of a patient’s records and medical information, without regard to the nature of the allegations in the complaint. However, statute provides that the Board should subpoena only information that is relevant to the investigation. In 3 of the 42 complaints we reviewed, the Board subpoenaed more records or information than necessary. One of these involved the chiropractor billing a patient $11 more than the co-pay. In that matter, the Board subpoenaed all the patient’s records, including health history, treatment plans, and x-rays. Requesting irrelevant information causes the chiropractor extra time to assemble and copy the records, and the board staff to review the records. It also may cause a perception that the Board is searching for statute or rule violations in addition to those identified in a complaint. Where possible, the Board should limit its subpoena to the minimum amount and type of information needed to address the complaint allegations. Some Arizona health regulatory boards limit the amount and type of records requested in subpoenas. For example, Podiatry Board staff indicated that complete medical records are not always necessary, and they are sometimes able to limit records requests to records associated with a particular event or situation." (Emphasis added)

The Board has indicated it will comply with this recommendation from the Auditor General. This is a great victory for ACS which has been aggressively pushing for this change for many years as can be seen by the following article which has been posted for years.

 


 

BROAD AND OPEN-ENDED CHIROPRACTIC BOARD SUBPOENAS BASED ON EVERY COMPLAINT MUST END

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The Arizona Chiropractic Board is the only regulatory board in Arizona and the only chiropractic board in the nation that takes every complaint and expands it into a general investigation into all practices in a doctor’s office. For example, if the Board receives a simple complaint about a financial issue such as an alleged overcharge by a doctor, the Board will issue a broad subpoena for the entire patient file. The doctor will be required to send in the patient file including all daily progress notes, exam forms, x-rays, bills, EOBs, etc.

The Board then puts all of these records through its “screen,” some of which is described on the Board’s webpage. The Board is especially meticulous in reviewing the manner in which doctors keep daily progress notes. In the majority of cases, the Board finds violations even though the doctor has complied with the letter of the law. The doctor is then given a non-disciplinary order for continuing education in record keeping and sent to hours of class.

This all sounds relatively benign until you find that the non-disciplinary orders are permanently posted online on the Board’s webpage with the doctor’s license information. To the general public, the perception is quite poor of a doctor who was required to take formal classes due to “failure to keep a proper professional record.” ACS has heard of many reports of doctors who have lost potential new patients because of online non-disciplinary orders.

ACS would have no objection if the doctors had actually violated state law regarding record keeping, but in most cases they did not. What they did do was fail to meet a standard invented by the Board to satisfy Medicare and insurance companies. The Board has decided to singlehandedly elevate chiropractic record keeping to Medicare and insurance standards under penalty of license discipline. The Board has gone far beyond its true mission of protecting the public health, welfare and safety.

It is the job of state associations to offer programs to doctors to improve record keeping if they so choose. The penalty for inadequate records should usually be limited to refusal to pay by a third party payer. It is very rare that records are so poor that they actually jeopardize public health, welfare or safety. The Board needs to stop acting as a proxy for Medicare and insurance companies, and simply do its job and only its job of protecting the public. ACS plans to drive hard to make this happen in the next year. Join us and help continue to push the agenda of Board reform forward in 2011!