April 2004

ACA discusses fraud with insurers

The American Chiropractic Association (ACA) recently met with leaders of many major insurance companies and managed care networks to tackle a top healthcare issue — fraud. The meeting marked the seventh gathering of the Claim Solutions Work Group, a biannual summit between representatives of ACA and major insurers, designed to address troublesome issues and improve communications and cooperation between doctors of chiropractic and the insurance industry.

The CSWG was held in Washington, DC, and featured 20 of the nation's top insurers, including Nationwide, Blue Cross Blue Shield, Allstate, Erie, Met Life and Liberty Mutual.

Prompted by the insurers’ requests to collaborate with ACA on ways to deal with healthcare fraud, the meeting included a discussion about different types of suspected fraud and the methods payers use to determine whether a given chiropractic insurance claim constitutes fraud.

ACA also worked with insurers to educate them on legitimate, routine chiropractic practices and treatments of which insurers might not have a full understanding and which give rise to complaints from doctors of chiropractic about some insurance companies’ overaggressive fraud investigation practices.

ACA plans to consider new ways of creating awareness within the profession for situations and actions that might lead providers into unnecessary and costly fraud investigations.

Source: American Chiropractic Association

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