Rule 80.9 – Repeal – Rules to Prevent Fraud
Wednesday, September 17, 2014 11:10 AM

The following section would be repealed.  Different language to "replace it" has been proposed elsewhere.

(a) Fraud and Abuse Policy. Health care fraud is everyone's concern. It exists, in some degree, in every health care profession and in every area of the United States. The Board takes a strong position against any form of healthcare fraud. Health care fraud can be defined as wantonly misleading or misrepresenting patient treatment circumstances or any other dynamic of the healthcare industry, resulting in any type of financial gain for the doctor, patient, or any other third party or entity. The Board opposes any type of fraud within the chiropractic profession, including insurers who use unfair medical review practices that create obstacles to chiropractic access and reasonable and necessary care for patient constitutes fraud and abuse. In particular, fraud in the practice of chiropractic should be prevented when filing workers' compensation and insurance claims.

(b) Fraud Definition. Fraud is defined as an intentional misrepresentation where the following conditions are present:

  (1) there must be a cause of deception;

  (2) the act or acts must show an intentional misrepresentation of fact; and

  (3) the provider must stand to gain financially from the deception and misrepresentation.

(c) Incorporation by Reference. As part of its policy for the prevention of fraud, the Board incorporates by reference into this section the following rules under this title: §71.2, relating to Application for License; §73.3, relating to Continuing Education; §75.1, relating to Grossly Unprofessional Conduct; §75.2, relating to Proper Diligence and Efficient Practice of Chiropractic; §77.2, relating to Publicity; and §80.5, relating to Maintenance of Chiropractic Records.