A pain in the neck

“Well-intentioned but flawed, nonetheless.”

That’s how Chico chiropractor Kristilyn Edwards described Proposition 44. Edwards, who has been practicing in Chico for more than four years, has followed the progress of the measure closely and said that, while she doesn’t necessarily oppose the spirit of Prop. 44, she’s deeply skeptical of the some of its supporters’ intentions.

“When I first heard of it, I just thought, ‘Well, here we go again,'” Edwards said. “What it does is let people assume that we’re engaged in unscrupulous practices in general, and that we need to be watched more closely, when that’s not the case at all. … It unfairly singles us out for scrutiny.”

Prop. 44, which is on the March 5 ballot, enacts harsh penalties for chiropractors found guilty of insurance fraud, requiring that those deemed guilty of second or multiple offenses lose their licenses for 10 years, no questions asked.

The measure also prohibits chiropractors from using “runners” or “cappers"—commonly known as “ambulance chasers"—who circulate around emergency rooms recruiting clients for chiropractors. It was overwhelmingly passed by the state Assembly last year but requires the public’s vote before it can become law.

Prop. 44’s major supporter is the California District Attorneys Association, which points out in literature about Prop. 44 that historically chiropractors (along with doctors, lawyers and auto repair technicians) have had a “higher than average” rate of insurance fraud.

But several local chiropractors say that’s untrue, and that the measure is actually akin to a Trojan horse by the American Medical Association, which has long mistrusted chiropractors and sought to tarnish their reputations by seeding public doubt about the medical services they provide.

In addition, said Dr. Jim Miller, another Chico chiropractor, it would set up “just another set of laws that we already have.” He added that insurance claims are notoriously complicated and difficult to file and “ripe” for mistakes, meaning that well-intentioned doctors could lose their licenses for simply erring when filing them. He estimates that he spends a full 50 percent of his time in the office poring over insurance claims.

“The state already watches us like hawks anyway,” Miller said. “I can’t see where we need even more oversight. You take away someone’s license, you’re taking away their livelihood, and I can’t understand what good that does for anyone.”

Supporters of Prop. 44 point out that the penalties it enacts are already enforced on California doctors, lawyers and automotive repair technicians. Why, they say, should chiropractors be any different?

The four industries (including chiropractic) were identified in an insurance fraud survey performed by a group of the state’s largest insurance companies, which found that doctors, lawyers, chiropractors and auto repair technicians were the biggest beneficiaries of fraudulent insurance claims, said Kim Smith, executive director of the Board of Chiropractic Examiners (BCE).

A measure passed by the state Assembly last year enacted Prop. 44’s penalties and rules onto doctors, lawyers and auto repair technicians and in fact aimed at doing the same for chiropractors, but the Chiropractic Act, passed in 1922, requires that changes to the rules governing the industry be approved by the voters.

Smith admitted that insurance fraud has indeed been a problem in the industry. But, she cautioned, “a few bad apples does not mean the whole barrel is bad.”

The BCE is the private, self-policing arm of the chiropractic industry and uses dues collected from member chiropractors to investigate claims of wrongdoing. The bulk of the department’s budget is spent on investigating charges of wrongdoing, she said.

“We acknowledge that insurance fraud is big money,” she said. “And yes, it has been a problem in the chiropractic community, but it’s also been an identified problem for the AMA, the state bar and auto body shops, so you can’t single out chiropractors.”

She said that the organization hasn’t taken an official stance on Prop. 44 but said that, if it passes, she hopes it will be a deterrent to the “few bad apples out there.”

Kristine Schultz, director of governmental affairs for the California Chiropractic Association, said that her organization hasn’t taken an official stance on Prop. 44, either.

“It could be seen in a lot of ways,” she said. “But in the end, it just makes chiropractors subject to the same laws that apply to other health care providers. That’s really what we’re saying about it.”

And that, said Chico chiropractor Dr. Russ Kalen, is a problem. He’s been fuming about the insurance companies who “cheated” him out of a whopping $50,000 in patient claims just last year. The additional “insult” of Prop. 44, he said, could be the final straw to get him out of the business entirely.

Although he said he’s never been accused of insurance fraud before, Kalen, who has been in practice for 15 years, said he “sees the writing on the wall” and is considering teaching the cranial-sacral chiropractic therapy he specializes in instead of practicing it.

“The way I see it, they want to take my license for 10 years if I defraud [the insurance companies], but what happens when they defraud me?” he asked. “Nothing.”

Kalen lamented that the state, and insurance companies, have been “working over” chiropractors for years. He used to be able to charge most patients’ insurance companies $45 for a legitimate office visit and alignment and expect to be reimbursed for almost the entire fee. Now, he said, he’s lucky to get back half of it. Medi-Cal, he pointed out, pays more for chiropractic visits than do most private insurance companies. The fees for his service, he said, have been going down, down, down for years. It’s gotten so bad that he no longer accepts most insurance and requires his clients to pay up front.

“I’m losing money right and left,” he said. “And it’s not like I’m a big rich doctor who’s getting greedy—I drive an old, beat-up truck.”

Prop. 44, he said, is “just another attempt by the insurance companies to put a stranglehold” on chiropractors.

“They want to silence anyone who would let patients know that they can get chiropractic care, which the insurance companies obviously don’t want to pay for," he said. "It’s a sad state of affairs when they want to put doctors out of business, and they will."