Greece Chiropractic Continuing Education

• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Identify various ingredients found in a typical judicial opinion
• Discuss what each chiropractic provider should look for when they read an opinion
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to legal opinions
• Encourage development and nurturing of skill sets in reading legal opinions by utilizing case method

• Describe each of the four elements of malpractice
• Differentiate between a bad treatment result and malpractice
• Define Duty, Dereliction of Duty, Direct causation, and Damage
• Search out a case report on-line or in a law library by using the case citation

• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to fee splits and kickbacks
• Explain the development of current fee-splitting laws
• Distinguish the letter of the law regarding fee-splitting and anti-kickback legislation from unprofessional conduct and consequent harms the statutes were enacted to discourage
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks
• Assess ones working knowledge regarding the process by which anti-referral safe harbors developed and how they operate

• Evaluate sample healthcare employment agreement
• Explain the components of a well drafted healthcare employment agreement
• Relate likely enforcement of provisions included in healthcare employment contract
• Assess non-compete provisions through a judicial balancing test
• Distinguish the various methods by which a court will rehabilitate certain contract provisions and selectively enforce others
• Explain what kinds of contract provisions may run afoul of state and federal laws, including fee splitting and kickback prohibitions

• Evaluate a sample sale agreement and sample letter issued to patients upon dissolution of practice
• Explain components of any well drafted buy-sell agreement including non-competes
• Identify how to handle patient records vis-à-vis the sale
• Understanding forms and laws relating to the transfer of logos, trademarks and Internet Domain Names
• HIPAA Considerations
• Acquaint oneself with the tax consequences of particular types of practice sales
• Discuss valuation methods used for determining an appropriate practice sales price
• Identify legal concerns associated with the dissolution of a healthcare practice
• Recognize how sales can trigger violations: fee splitting, patient abandonment, kickback, and anti-trust

• Identify "high risk" patients
• Design protection strategies for telephone "advice."
• List the "4 D's" of malpractice
• Differentiate clinical from administrative malpractice risks
• Distinguish malpractice from an adverse patient outcome
• Describe how a non-office encounter can create a dr/patient relationship
• Give examples of statutory duties beyond clinical care
• Explain how you can be guilty of malpractice without being negligent
• Assess office equipment hazards
• Discuss malpractice cases where patient was never given an adjustment

• Discuss problems created by leaving blank spaces in records
• Create practice appropriate SOAP note format to reduce risk exposures
• Recognize Health Questionnaire “red flag” responses

• Integrate protective “rules for recordkeeping"
• Monitor records release authorizations
• Individualize pre-printed forms to conform with your practice and reduce risk exposures

• Identify and document significant patient non-compliance
• Generate appropriate X-ray warning labels
• Identify “bad” forms
• Incorporate protective letters-writing protocols

• Recognize “exposure events” in area's of potential risk management
• Discuss proper communication of a potential exposure event with a malpractice carrier
• Maintain a healthy practice while in litigation
• Prepare staff for dealing with the publicity of litigation

• Prepare for a deposition
• Identify “informed consent” compliance
• Analyze your website for potential risk management issues
• Recognize deposition “tricks & traps”

• Properly prepare for a trial
• Prepare for lawyers questioning techniques
• Avoid detrimental body language in front of a jury
• Prepare for the phases of trial and the "down time" associated with trial

• Find and Analyze Chiropractic Malpractice Court Opinions
• Justify referral protocols
• Plan staff training to avoid "vicarious liability"
• Interpret "lawyer-speak" like "vicarious liability"
• Assess equipment risk
• Differentiate between good PR & sexual harassment
• Generate HIPAA compliance strategies w/o paranoia
• Appraise partnership, independent contractor and doctor/associate risks
• Implement Table safety procedures
• Recognize "exposure events"

• Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct..
• Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies.
• Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees.
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements.
• Explain the development of current fee discounting legislation, rules and holdings.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks.
• Assess one’s working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider’s practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally.
• Verify how certain discount practices may be legally actionable as “improper inducements.”
• Evaluate federal Stark legislation and the discouragement of corruption in sound professional healthcare decision-making.
• Identify distinctions between federal anti-kickback and the federal Stark legislation.
• Critique state anti-kickback laws.
• Recognize the role the FTC played, and continues to play, in discouraging the fraudulent marketing of discount health care programs.
• Draw associations between co-pay requirements, consumer habits and federal healthcare expenditures.
• Assess how "professional courtesy" discounts may raise enforcers' concerns under the federal anti-kickback statute.
• Diagram how prepaid fee arrangements often resemble health insurance to unwitting patients.
• Illustrate pitfalls that advertising discounts visit on the practitioner.

• Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct..
• Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies.
• Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees.
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements.
• Explain the development of current fee discounting legislation, rules and holdings.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks.
• Assess one's working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider's practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally.

• Assess how state scopes of practice affect chiropractic treatment of nutrition-related health problems.
• Identify the roles the FDA and FTC play in the administration of nutritional healthcare.
• Distinguish between a "food" and a "drug" for purposes of nutritional supplementation.
• Demonstrate how the various states' ban against the practice of medicine affects other disciplines' approach to nutritional healthcare.
• Explain aspects of nutrition labeling.
• Identify issues associated with current performance-enhancing supplementation.
• Explain the significance of distinguishing "treatment" from "informing" as it relates to nutritional counseling.

• Assess the relationship between the implementation of efficient office systems, accurate record keeping, patient communication, and adherence to professional standards of conduct within the context of malpractice allegations by patients who engage in sports.
• Identify actions suggestive of malpractice negligence and conduct that fails to live up to the standard established by law for the protection of others.
• Demonstrate a professional relationship can spring into existence when the healthcare professional is hired by a third party to oversee the health of athletic participants.
• Distinguish the duties an examining physician has regarding informing those athletes he examines about abnormal test results.
• Explain the legal concept of “assumption of the risks” within the context of sports participation and how it affects a healthcare professional’s liability.
• Identify “therapeutic exceptions” to providing informed consent excusing the practitioner from fully disclosing matters where they might unfavorably affect the outcome of a patient’s treatment.
• Explain a healthcare professional’s duty to warn patients engaged in sports regarding injury prevention following treatment.
• Examine a practitioner’s duties regarding athletes’ return to play in instances when head injury and concussion may be a factor.

• Assess the role the doctor-patient relationship plays in allegations of Patient Abandonment
• Identify the components to any successful Patient Abandonment charge
• Discuss court cases evaluating whether the doctor-patient relationship had been terminated lawfully
• Distinguish between proper and improper considerations a doctor may rely upon to either refuse to undertake, or to terminate, a doctor-patient relationship
• Explain the role notice plays in lawfully terminating a doctor-patient relationship
• Evaluate the role consent plays in the establishment of the doctor-patient relationship, and in subsequent treatment

• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to fee splits and kickbacks
• Explain the development of current fee-splitting laws
• Distinguish the letter of the law regarding fee-splitting and anti-kickback legislation from unprofessional conduct and consequent harms the statutes were enacted to discourage
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks
• Assess ones working knowledge regarding the process by which anti-referral safe harbors developed and how they operate

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the practice of forensic science
• Identify a new dimension of chiropractic practice that will minimize risks and failure in court appearances as a practitioner
• Construct skill sets in forensic examination and document review

• Acquire a current knowledge base relating to medicolegal issues
• Identify risks and liabilities that may be encountered by examiners with electronic communications
• Develop a level of understanding of the medicolegal system as it relates to Junk Science

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the ethical expert witness
• Introduce a new dimension of chiropractic practice that will minimize risks and failure in court appearances as an ethical expert witness.
• Encourage development and nurturing of skill sets in forensic examination and appearing as an expert witness through certification.
• Develop a level of understanding of the medicolegal system as it relates to the ethical expert witness.

• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Identify Daubert criteria
• Discuss what each chiropractic expert should look for when preparing for the opposing attorney
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to Daubert challenges
• Encourage development and nurturing of skill sets in proving expert opinions

• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Identify the basics of a deposition
• Discusses the tricky question types and suggested responses
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the deposition process
• Encourage development and nurturing of skill sets in responding to questions posed in a deposition

• Perform professional advertising and marketing that passes state and federal legal restriction.
• Comprehend requirements for advertising testimonials, press releases, television, radio, Internet, personal solicitation and other marketing initiatives.
• Comprehend the limits of commercial speech (advertising) within the arena of professional healthcare marketing and dissemination of information.
• Train staff and implement policies associated with marketing initiatives and materials vis-a-vis state rules, regulations and statutes.
• Comprehend issues associated with signage, listings, letterhead, and other matters of ostensible agency that may lead to liability.
• Administer professional marketing such that it neither misleads, confuses nor exploits members of the public.
• Discuss how nutritional supplementation labeling and HIPAA affects professional healthcare marketing efforts.
• Undertake a review of marketing materials and initiatives so as to ensure compliance with relevant state rules, regulations and statutes.
• Administer coverage decisions, professional referrals, and communicate same in a manner that limits professional liability.

• Analyze charges and documentation on a daily or per visit basis to ensure accuracy and compliance
• Compile accurate and comprehensive responses to documentation or record requests
• Recognize and avoid confusing HIPAA privacy issues that can cost you time and money
• Identify key areas that lack written policies causing increased risk in the practice
• Evaluate your current written procedures and appraise the need for additional content

Hour 1

• Identify various types of billing irregularities and impact on healthcare expenditures.
• Distinguish upcoding from bundling within the context of irregular billing schemes.
• Demonstrate how and when exceeding a state’s scope of practice becomes “the unauthorized practice of medicine.”
• Explain the restrictions states’ scopes of practice place on healthcare providers’ authority to treat and diagnose patients.
• Discuss how invoicing unrendered medical services impacts third-party payers.
• Interpret chiropractic boards’ positions on testimonial advertising and how best to comply.

Hour 2

• Identify what constitute a false claim under the False Claims Act.
• Discriminate a kickback from a self-referral.
• Trace how anti-kickback legislation arose and examine its prohibitions.
• Explain the enactment of Stark legislation arising on the heels of anti-kickback bans.
• Assess providing nutritional counsel within the context of “the practice of medicine.”
• Evaluate identity theft and its impact on patients, providers and the cost of healthcare.
• Discriminate between illegal copayment waivers from proper hardship waivers.
• Discuss court cases instancing successful prosecution of healthcare fraud.

• Identify the 18 PHI Identifiers
• Awareness of other HIPAA related documentation and the appropriate retention period
• How to confirm retention period for healthcare records
• Recognize required security measures and their value to practice risk management
• Implement policy and protocol for compliant and secure disposal of records

• Be able to identify the definitions of Fraud, Waste and Abuse and how they may show up in day-to-day practice
• Become aware of the source of overpayments, including not-medically necessary care, maintenance care, and active treatment
• Apply the guidance from the OIG to your state and carrier regulations since they are a resource to these groups
• Recognize insufficient documentation and incorrect coding before the billing takes place
• Implement the action steps recommended by the OIG to eliminate incorrect documentation, billing and coding practices to reduce compliance risk

• Distinguish between fraud, waste and abuse
• Review and properly utilize your Medicare Local Coverage Articles (LCA)
• Integrate critical compliance requirements for minimum, mandatory, annual self-audits  
• Detect common billing protocols that are red-flags for third-party auditors and chiropractic boards of examiners