Petaluma Chiropractor Accused of Billing Fraud

May 3, 2006

By DAN JOHNSON

ARGUS-COURIER STAFF

Several patients of a Petaluma chiropractor have demanded their money back after discovering that he billed their Medicare card after they pre-paid for the same services.

The patients claim that Daniel Marsh, who runs Marsh Chiropractic at 231B N.

McDowell Blvd. in the Plaza North Shopping Center , has been giving them discounts for pre-paid series of treatments and subsequently billing their Medicare cards for the same amount. For some people, thousands of dollars are involved, and Tammy Mulligan, Marsh's former billing consultant conservatively estimates that a cummulative total of over $50,000 has been double billed to hundreds of Marsh's patients.

Mulligan worked for Marsh from April to October of 2005, and became aware of the alleged double-billing on her first day of work, and promptly confronted him.

"I told him that it's against the law to ask for up-front payments from Medicare patients, and to then bill their insurance," she said. "I told him, 'If you continue this, you can be fined big-time, about $1,500 per case.'

"He didn't look surprised. He looked at me and said, 'Medicare has bigger fish in the sea than me to worry about.' I could tell he knew what he was doing by the way he answered."

Mulligan notified Medicare officials about Marsh's alleged activity, and they sent him a letter indicating they were aware of it. She also began compiling a list of patients who had been double-charged, and called many of them about the matter.

In October, Marsh's office suddenly stopped calling Mulligan to help with medical billing.

"But I felt that people should be aware of his illegal behavior," she said.

Mulligan urged a friend, George Devine of the sports department at KGO-TV in San Francisco , to mention it to investigative reporter Dan Noyes, who in turn did a story about it.

It first aired in two parts during evening news shows on Thursday, and Noyes now is working on another piece on Marsh's behavior.

Marsh declined to be interviewed for the story, but on Monday, his office sent a brief letter of explanation to the Argus-Courier, along with a patient's positive testimonial of his character and work.

A portion of Marsh's letter states, "While the vast majority of our patients are very satisfied with our care, the San Francisco television station unfortunately chose to ignore the numerous satisfied patients they interviewed, and focused only on a few who were not.

"We established a discount plan to make chiropractic care more affordable.

Medicare provides very limited coverage for chiropractic services and their regulations are extremely complex. We are making appropriate revisions to these plans to be sure that we meet all of the regulatory requirements."

Mulligan says no civil or criminal charges have been filed, but Dr. Robert Baratz, president of the National Council Against Health Fraud, suggests that both civil and criminal lawsuits are possible.

"Even if patients receive restitution, the U.S. Attorney General's Office could decide to pursue a criminal case. This office can go to the U.S. Grand Jury and try to obtain an indictment, but it normally doesn't do so unless enough money is at stake to make an investigation worthwhile."

While decrying Marsh's alleged behavior, Baratz says it isn't all that unusual.

"Dishonest people are found in every profession, but the bottom line is that most people don't have the energy or inclination to deal with this type of behavior," he said.

And he warns that where there's smoke, typically there's raging fire.

"Whenever I see a case like this, there's usually 10 times as much illegal behavior to be found," he said. "When investigators do a sweep and start pulling records, a lot of 'Oh, my God!' starts happening."

During the second KGO-TV segment Thursday, the authenticity of some of Marsh's practices also was questioned.

One patient, John Valverde, mentioned that Marsh rested two boxes with lights on his chest, apparently for muscle stimulation. After receiving the treatment for 90 minutes and paying $330, Valverde said he noticed no improvement.

"I'm very familiar with different types of muscle stimulation machines, but I'm not aware of the machine he mentioned," said Kassie Donoghue, president of the California Chiropractic Association.

She is aware of Marsh's alleged behavior, but says he's not a member of her association, and that the California Board of Chiropractic Examiners would be the likely chiropractic body to investigate.

Baratz says that the parameters for chiropractic practice in California are much looser than in many other states, and that this makes it difficult to regulate dubious practices.

"It's like having foxes guard hen houses," he said. "Chiropractors claim that subluxations (where one or more of the bones of the spine moves out of position and creates pressure on, or irritates spinal nerves) interfere with the energy flow in the body, and that their treatments help to correct it.

But no objective tools show that subluxations exist."

"Studies show that for lower, muscular-skeletal back pain, some chiropractic treatment can be helpful to some people, but not necessarily any more than such things as exercise and massage," Baratz added.

Donoghue claims many chiropractic treatments are validated by scientific research, but emphasizes the need for regulation.

"A lot of research, including many anecdotal cases, gives scientific validity to many types of chiropractic practice," she said. "In California , we're essentially able to do all sorts of physiotherapy, and can adjust any joint in the body.

"We're allowed to treat any condition," she said. "But chiropractors need to be very clear to their patients what they can and cannot do, and should refer people they can't treat to other practitioners."