Members should be aware; the FTC has developed Red Flag Rules which require “creditors” – including health care providers -- to conduct a risk assessment to determine if they have accounts at risk for identity theft. These rules went into effect in November, 2008 with an implementation date of May 1, 2009. The AMA disputed the FTC’s inclusion of health care providers as creditors, but the FTC determined that health care providers do fall within the ambit of the rules. According to the Equal Credit Opportunity Act, a “creditor” is “any person who regularly extends, renews or continues credit.” “Credit” is defined as a “deferment of payment for goods or services rendered.” For health care providers, this means every time you submit a health insurance claim to an insurance carrier first, and then bill the patient for co-payments or deductibles after services are rendered you are deferring payment and thus are acting as a “creditor.” Medical identity theft occurs when an individual seeks care using the name or insurance information of another person. This can result if false billing and potentially life-threatening corruption of a patient’s medical records. The bottom line comes in assessing risk in your practice of possible identity theft. The FTC requires that office practice’s have written policies in place – an “Identity Theft Prevention Program” -- and a plan to “prevent and mitigate” the effects of identity theft. If you have a small practice in which all your patients are known to you or your staff, you are at lesser risk and may only need an initial copy of a state issued photo ID that is checked at each visit to ensure that the patient is who he/she says she is. There is greater risk in a large multi-doctor office or facility. It would also be required to have a procedure in place in the event that you are notified by a state or local agency that the consumer’s identity has been misused. In order to assist the membership with implementation of the Red Flag Rules, the NYSCA has put together a “Model Identity Theft Prevention Program” for members. In addition to all the information and contacts you would need in case of identity theft, this includes a “turn key” manual that only requires you to fill in your office information. They do require you to have a meeting to explain the new procedures to your staff. Everything else is done for you. Many groups are selling packages for $100 or more; as a member benefit, the Red Flag Rules package can be downloaded from the NYSCA website free-of-charge. Download your copy, fill in the information and be in-compliance by the May 1, 2009 deadline. Membership has its privileges. Sincerely, Mariangela Penna, DC President, New York State Chiropractic Association GO TO MEMBERS ONLY TO VIEW THE “Model Identity Theft Prevention Program” by clicking on the link below:

Red Flags Rule Enforcement Delayed Three Months Due to Congressional pressure supported by ACA, the Federal Trade Commission announced today it will delay enforcement of the new "Red Flags Rule" until August 1, 2009. This will give creditors and financial institutions more time to develop and implement written identity theft prevention programs. ACA will continue to monitor this important policy and support members in compliance. More information on the Red Flags Rule

The Virginia Chiropractic Association (VCA) and the Virginia Society of Chiropractic (VSC) announced their intent to unite into a single entity and the formation of a Unification Committee. The unification will create a single, more influential association in the Commonwealth of Virginia that will better serve chiropractic doctors, patients, and the profession as a whole. The goal is to reduce duplication, allowing the profession to devote more resources and expertise to public policy, education, legal and legislative initiatives. Over the past several years, the organizations have begun collaborating more and more frequently, assisting each other in legislative activities and conducting joint educational programs. Both presidents accepted honorary memberships in the other organizations and face-to-face meetings and conference calls between the two Boards and staff became regular occurrences. The Unification Committee is charged with fleshing out the myriad of organizational, operational, and legal details and considerations involved in bringing the two groups together. In addition, it will outline a plan to provide a framework for the rules that will govern the organizations during the consolidation period, thereby ensuring a smooth transition.

Seneca Falls: Saturday, April 4, New York Chiropractic College held commencement exercises in the campus Athletic Center and conferred degrees upon 44 candidates in its Doctor of Chiropractic program. The commencement address was delivered by Carl S. Cleveland III, DC, who has served as president of Cleveland Chiropractic College since 1981 and is a noted author, educator and international lecturer. A fourth generation chiropractor, Dr. Cleveland is the grandson of the college’s founders, Dr. Carl S. Cleveland, Sr. and Dr. Ruth R. Cleveland and he has served as president for the Association of Chiropractic Colleges and for the Council on Chiropractic Education. Valedictorian, Robert James Sedlor addressed his classmates and Catherine Elizabeth McArdle was salutatorian. During the ceremony, the eighth annual convocation of the American College of Chiropractors recommended the following to be enlisted as Fellows: Carl S. Cleveland, III, DC; NYCC Board of Trustees member George M. McCllenad, DC; NYCC faculty member Vincent F. Loia, DC (NYCC 1981); and Ms. Laurie Reynolds, Executive Assistant to the President of NYCC and Executive Secretary to the NYCC Board of Trustees. For further information about New York Chiropractic College’s degree programs please visit

The May 2009 issue of Consumer Reports Magazine reports the results of its recent survey of more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. About 80 percent of U.S. adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half-said pain severely limited their daily routine for a week or longer and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weigh… This article is the archived version of a report that appeared in May 2009 Consumer Reports Magazine. Read the entire Consumer Reports Magazine report by clicking on the link below: Consumer Reports Magazine Reports on Aching Backs

Doctors beware: There are many rumors within the chiropractic profession about Medicare policies. ---Did you know that you still have to bill Medicare if you are a non-participating (non-par) physician? ---You still have to follow Medicare documentation requirements if you are non-par? ---You are still subject to reviews if you are non-par? There is no visit cap for chiropractic in Medicare? Read the MLN matters article by clicking on the link below:

WASHINGTON, D.C. —During a conference call today with reporters, Senator John D. (Jay) Rockefeller IV (D-W.Va.), Chairman of the Senate Finance Subcommittee on Health Care, and Congressman Joe Courtney (D-Conn.), Member of the House Education and Labor Committee, announced the introduction of the Pre-existing Condition Patient Protection Act that would end insurance discrimination against those who live with pre-existing or chronic illness. “We have 133 million Americans living with chronic illness – insurance companies should no longer be allowed to reap profits by denying care to sick Americans,” said Senator Rockefeller. “We as a nation can no longer stand by and continue to allow this practice to occur. These medical services are not optional, and most times, they are not affordable without insurance. Our system is broken—which is why we must eliminate the ability of insurers to deny coverage for pre-existing conditions in every single market. The time for serious action is now.” “It is wrong and impractical to commit ourselves to health care reform without addressing the faulty and ill-advised pre-existing condition exclusion,” stated Congressman Courtney. “This discriminatory practice prevents millions of hardworking Americans from changing or finding new jobs and in this economy that is just plain wrong. Senator Rockefeller and I agree that it is time for the most advanced nation in the world to have a world-class health care system that is fair and affordable.” Background The Pre-existing Condition Patient Protection Act will eliminate pre-existing condition exclusions in all insurance markets, a major step forward for the 133 million Americans living with at least one chronic condition. Eliminating pre-existing condition exclusions is a priority of the Obama Administration and Senator Rockefeller and Congressman Courtney plan to work closely with President Obama to enact this vital legislation. Insurance market reform must be a central part of comprehensive health reform. Both Senator Rockefeller and Congressman Courtney believe that all individuals should have access to comprehensive, meaningful, and affordable health insurance coverage—and this legislation is a critical component of achieving that goal. Summary of the legislation ****The Pre-existing Condition Patient Protection Act is a bill to protect consumers excluded from receiving health insurance coverage due to a “pre-existing condition.” ****The Pre-existing Condition Patient Protection Act would require the Secretary of Health and Human Services to submit a report to Congress on the extent of adverse selection (i.e. which happens when less healthy people disproportionately enroll in a risk pool) that occurs because insurers can no longer exclude patients with pre-existing conditions. This report must include data from private insurers on the characteristics of their insured population. This new reporting requirement would provide transparency on the true mix of patients and patient claims experience among private insurers; and ****Require the Government Accountability Office to submit a report to Congress addressing the impact of this legislation on reducing the number of uninsured and underinsured, as well as its effect on the affordability of health insurance coverage. This is meant to highlight both the positive impact this new policy will have on making coverage more accessible for individuals with chronic conditions, but also recognize that without further regulatory changes, coverage may not be affordable for these individuals. ****The Pre-existing Condition Patient Protection Act of 2009 has been endorsed by twenty-two organizations, including: American Autoimmune Related Diseases Association; American Heart Association/American Stroke Association; Association of Black Cardiologists, Inc.; Association of Community Cancer Centers; Breast Cancer Network of Strength; Children’s Cause for Cancer Advocacy; Congenital Heart; Information Network; Dermatology Nurses’ Association; First Focus; International Myeloma Foundation; Lung Cancer Alliance; Lupus Foundation of America; Mended Little Hearts; National Association of Pediatric Nurse Practitioners; National Patient Advocate Foundation; Oncology Nursing Society; Ovarian Cancer National Alliance; Pediatric Stroke Network, Inc.; Sarcoma Foundation of America; Sudden Cardiac Arrest Association; The Leukemia & Lymphoma Society; and The Wellness Community.

Federal Trade Commission (FTC) regulations stating that financial institutions and creditors are required to develop and execute written identity theft prevention programs otherwise known as the “Red Flags Rules,” are slated to go into effect May 1, 2009. Until recently, there was much ambiguity regarding the regulations and questions were raised as to whether physician offices fell under the FTC red flags guidelines. In February, the FTC issued a statement clarifying that Identity Theft Red Flag Rules do indeed apply to physicians including doctors of chiropractic. Read the FTC statement by clicking on the link below:

BLOOMINGTON, Minn. – Jonathan Williams, DC, MEd, EMT-B, DABCI, CCSP, an associate professor at Northwestern Health Sciences University, recently wrote a book with guidelines for athlete injuries and return to play (RTP) recommendations. “My hope is that coaches, athletic trainers, and chiropractic physicians will be able to use the book to make rational decisions about when athletes should be put back in the game,” Dr. Williams says. “Hopefully by using this book, progression of athlete injuries can be prevented.” The 31-page-book, titled “Emergency Care of the Injured Athlete and Return to Play” contains signs and symptoms, treatments, and RTP recommendations for a range of conditions including bee stings, concussions, and heat-related syndromes. Dr. Williams says the idea for the book came out of a necessity. “I was looking around at different organizations for RTP ideas, and nobody had them,” he explained. Dr. Williams is currently teaching the Sports Medicine courses at Northwestern, and directs the Sports Medicine Clinic at St. Agnes Schools in St. Paul, Minn. He also coordinates the chiropractic doctors who cover St. Agnes high school varsity athletic games. The book will be sold at the University’s bookstore for approximately $11, and orders for the book were taken during Northwestern’s chiropractic homecoming which took place Feb. 5-7, 2009. Dr. Williams says the book will also be sold on the University’s website. Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 900 students on a 25-acre campus in Bloomington, Minnesota.

Vitamin C Intake and the Risk of Gout in Men Abstract A Prospective Study Background Several metabolic studies and a recent double-blind, placebo-controlled, randomized trial have shown that higher vitamin C intake significantly reduces serum uric acid levels. Yet the relation with risk of gout is unknown. Methods We prospectively examined, from1986 through 2006, the relation between vitamin C intake and risk of incident gout in 46 994 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. Vitamin C intake was assessed every 4 years through validated questionnaires. Results During the 20 years of follow-up, we documented 1317 confirmed incident cases of gout. Compared with men with vitamin C intake less than 250 mg/d, the multivariate relative risk (RR) of gout was 0.83 (95% confidence interval [CI], 0.71-0.97) for total vitamin C intake of 500 to 999 mg/d, 0.66 (0.52-0.86) for 1000 to 1499 mg/d, and 0.55 (0.38-0.80) for 1500 mg/d or greater (P < .001 for trend). The multivariate RR per 500-mg increase in total daily vitamin C intake was 0.83 (95% CI, 0.77-0.90). Compared with men who did not use supplemental vitamin C, the multivariate RR of gout was 0.66 (95% CI, 0.49-0.88) for supplemental vitamin C intake of 1000 to 1499 mg/d and 0.55 (0.36-0.86) for 1500 mg/d or greater (P < .001 for trend). Conclusions Higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake may be beneficial in the prevention of gout. Authors Affiliations: Division of Rheumatology, Department of Medicine, Arthritis Research Centre of Canada, Vancouver General Hospital, University of British Columbia, Vancouver, Canada (Dr Choi); Channing Laboratory (Drs Choi, Gao, and Curhan) and Renal Division, Department of Medicine (Dr Curhan), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston (Drs Gao and Curhan). Dr Choi is now with the Rheumatology Section, Clinical Epidemiology Unit, Boston University School of Medicine, Boston. Arch Intern Med. 2009;169(5):502-507.

After carefully listening and reviewing member comments, the Foundation for Chiropractic Education and Research has opened its popular new DCConsult® website to all at no cost. The former subscription only site has been revamped, with a new emphasis on the needs of the practicing clinician. Driven by two major search engines anyone can now visit www.DCConsult.com and instantaneously run a search for the most current research abstracts. A click of a button and the site immediately translates from English to Spanish, French, German, Italian or Portuguese. For the past two years, it has been the goal of the FCER’s Board of Trustees to provide easy access for the profession to the literature, articles, links, educational products and more. DCConsult is now the globally recognized repository of such information. From South Africa, Evalie K. Heath, DC writes, “This is Wonderful news. A Very Big Thank you for your new policy to make DCConsult available to everyone at no cost. DCConsult will be a wonderful tool for ALL Chiropractors to access chiropractic articles, research and news. Those of us in more remote areas of the Earth (remote from Chiropractic schools and centers of research) and especially those in areas with economic difficulties greatly appreciate this decision.” Dr. Heath goes on to encourage colleagues in Uganda, South Africa, Nambia, Mozambique, Mauritius, Kenya, Ghana, Ethiopia, Congo: “Dear Africa Members, DCConsult opens the world of Chiropractic information to our very finger tips. Please enjoy this new privilege. Please inform all of your members and colleagues.” FCER’s President, Dr. Charles Herring stated, “As long as new research and articles emerge – DCConsult will never be finished. Information, as well as translations are being added as quickly as possible. The web site will continually change – so visit often.” FCER Vice President, Dr. Ronald Evans explains, "Moving DCConsult into the open access domain has not been without significant challenges. Newer site designs require more data to keep content current. FCER/DCConsult is seeking volunteer expertise to make the content more robust in several ways: 1) Contribution of original Evidence Based Medicine/Evidence Based Principles (EBM/EBP) material, 2) Abstract mining from any source germane to chiropractic science, 3) Book/Textbook recommendations for a website book list, and 4) Occasional chiropractic research consultancy. Never before in the 65-year history of this foundation has the need been greater for the chiropractic profession to step forward and assist with a project of this global magnitude." Coming soon is a FCER Member only section offering free audios, patient handouts and other downloads especially for those who financially support FCER activities. DCConsult would not be possible without the support of Standard Process Inc., National Board of Chiropractic Examiners, Future Health Inc., Academy of Chiropractic Orthopedists, American College of Chiropractic Consultants, College on Forensic Sciences and others. The Foundation for Chiropractic Education and Research celebrates its 65th Anniversary in 2009. FCER is a 501(c)3 not-for-profit foundation with a mission To promote the health and well being of humanity by encouraging and supporting research and education relative to the field of chiropractic care, and to provide information needed to document and improve chiropractic healthcare capacity worldwide. DCConsult directly aligns with FCER’s mission and is worthy of your support.

SENECA FALLS – New York Chiropractic College today announced that it, in cooperation with Community Health magazine and The Finger Lakes Times, will host its Eighth Annual Women’s Health Symposium, Saturday, March 28, 2009, on the NYCC campus on Route 89 in Seneca Falls. The 2009 keynote speakers include Mary Balliett, DC, assistant professor at NYCC; Donna Finando, MS, LAc, LMT; and Natali Cher, MD, DO. Sponsored in part by M&T Bank, the symposium also will feature a trade show and professional vendors. This year’s topic, “Wellness At Home,” focuses on important health issues regularly faced by families and will provide the public with insights to help build better communication with their healthcare providers. A second track is also provided for healthcare professionals that will speak to the topic, “Helping Your Patients Help Themselves” and teaches practitioners effective methods of patient education. Continuing education credits are awarded - 6 chiropractic postgraduate or 6 AOM PDA points – all other professionals should check with their accrediting agencies. Members of the public are charged $10 per person. Attendance includes a continental breakfast, admission to the lecture, fact-filled note pack, gift tote, and a luncheon featuring a panel discussion with guest speakers that include NYCC faculty Jason Wright, MS, LAc, NCCAOM, and Robert Ruddy, BS, DC. Registration/check-in on the day of the event begins at 8:00 AM. Registration for the professional track is $110, and includes all of the above plus 6 postgraduate credits. Due to the popularity of this event, pre-registration is strongly recommended. For more information, directions to New York Chiropractic College, or to register, please visit the college’s web site at www.nycc.edu/WHS. Because seating is limited, it is advised to pre-register as soon as possible.

(Arlington, Va.) -- The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) today expressed support for newly introduced legislation in the U.S. House of Representatives designed to codify chiropractic as a covered service through the Department of Veterans Affairs (VA) health care system. Representative Bob Filner, D-Calif., introduced HR 1017 late last week. The bill, which is similar to legislation introduced in 2007, specifically requires the VA to have a doctor of chiropractic on staff at all VA medical facilities by 2012. It also amends the current statute, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001, ensuring that chiropractic benefits cannot be denied. “The ACA and ACC applaud the work of Rep. Filner as he continues to advocate for both chiropractic and our nation’s veterans,” said ACA President Glenn Manceaux, DC. “Veterans want, need and deserve access to chiropractic care, and it is our goal to ensure that chiropractic is ultimately available and accessible at every major VA health care facility.” Further, ACC President Dr. Carl Cleveland III noted, “The chiropractic educational community welcomes the opportunity to position its graduates and the profession to serve our nation’s veterans, and this legislation allows veterans’ easier access to chiropractic care. With a reported 49 percent of eligible veterans returning with neuromusculoskeletal issues, the need for expanded access to chiropractic services has never been more crucial.” Through previous congressional action, chiropractic care is now available at 32 VA facilities across the country; however, in the more than 120 facilities without a chiropractor on staff, the chiropractic care benefit Congress authorized for America’s veterans remains virtually non-existent. Detroit, Denver, and Chicago are a few examples of major metropolitan areas without a doctor of chiropractic available at the local VA medical facility. According to ACA Vice President of Government Relations John Falardeau, without a congressional directive, further expansion to VA facilities will be on a case-by-case basis and will be excruciatingly slow. The ACA believes that integrating chiropractic treatment into the VA health care system would not only be cost-effective, it would also speed the recovery of many of the veterans returning from current operations in Iraq and Afghanistan. A January 2009 report from the Veterans Health Administration indicates that over 49 percent of veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report. HR 1017 has been referred to the House Committee on Veterans’ Affairs. To view the full text of HR 1017, click here. Contact your Member of Congress and urge them to cosponsor HR 1017.

CIGNA Signs Agreement to Deliver Fair Rates to Patients Nationwide; Will Contribute $10 Million to New, Independent Database Cuomo Also Announces Intent to Sue Rochester-Based Excellus for Defrauding Consumers by Manipulating Rates, Relying on Outdated Information Attorney General Andrew M. Cuomo today announced further expansion of his historic reform of the national healthcare reimbursement system. Cuomo has reached an agreement with CIGNA (NYSE: CI), one of the nation’s ten largest health insurers, in his ongoing drive to end industry-wide conflicts of interest and generate fair reimbursement rates for working families nationwide. CIGNA will end its relationship with the defective Ingenix database, as well as pay $10 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers. The agreement today with CIGNA brings the total dollar amount secured by Attorney General Cuomo for the new database to over $80 million. Attorney General Cuomo also announced that his office has served a five-day notice of intent to sue Excellus Health Plan (“Excellus”) for defrauding consumers and patients across Upstate New York by manipulating reimbursement rates for out-of-network services. Rochester-based Excellus is the largest not-for-profit insurer in New York State, and is the largest insurer in the Rochester and Syracuse areas. Excellus and its affiliates serve nearly two million people in 31 counties, with approximately 872,000 members in Rochester, 549,000 in Syracuse and Central New York, 289,000 in Utica, and 165,000 in Buffalo, where it operates as Univera Healthcare (“Univera”), one of the Buffalo area’s three largest insurers. Cuomo's case against Excellus includes information provided by the Syracuse Post-Standard newspaper showing that Excellus was under-reimbursing the Post-Standard's employees, who were members of Excellus. “Today’s agreement with CIGNA is the latest domino to fall in our industry-wide sweep of the healthcare reimbursement system and brings us another step closer to complete reform,” said Attorney General Cuomo. “Unfortunately, on the same day, we have another company that has continued to stand squarely in the way of our efforts. The bottom line is that Excellus failed to satisfy promises made to its members to deliver fair rates and give patients what they paid for. Let this notice today serve as a firm reminder to other insurers who have not yet resolved this problem - we will not hesitate to pursue legal action against companies that defraud patients.” Earlier this month, Attorney General Cuomo announced sweeping reforms to end the manipulation of reimbursement rates at the expense of patients across the country. After a year-long investigation revealed that the health insurance industry relied on a defective database to set rates, Cuomo reached groundbreaking agreements with UnitedHealth Group Inc. (“UnitedHealth”) (NYSE: UNH), the owner of the Ingenix database and the second-largest insurer in the country, along with Aetna (NYSE: AET), the nation’s third-largest health insurer. After those initial agreements, Cuomo brought his reform efforts to Upstate New York, securing agreements with the Schenectady-based MVP Health Care/Preferred Care as well as Independent Health and HealthNow, both Buffalo-based insurers. Attorney General Cuomo’s investigation concerned allegations that as a subsidiary of UnitedHealth, Ingenix had a vested interest in helping set rates low, so companies could underpay patients for out-of-network services. The investigation revealed that the database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits, meaning consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate - a large portion of which the insurer then reimburses - creates an incentive for the insurer to manipulate the rate downward. The establishment of a new database, independently owned and operated by a nonprofit organization, is designed to remove this conflict of interest. Under the agreement secured with UnitedHealth, the database of billing information operated by Ingenix will close. UnitedHealth also agreed to pay $50 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States. Cuomo’s agreement with Aetna, which will also end their relationship with Ingenix, secured another $20 million for the database. Today’s agreement with CIGNA, which insures 12 million people nationwide, brings the total dollar amount to $80 million. Under the terms of the agreement: • CIGNA will pay $10 million toward a new, independent database run by a qualified nonprofit organization; • The nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database; • The nonprofit will develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area; • The nonprofit will make rate information from the database available to health insurers; • The nonprofit will use the new database to conduct academic research to help improve the health care system; • The nonprofit will be selected and announced at a future date. Cuomo also announced today that he has served a five-day notice of intent to sue Rochester-based Excellus for defrauding consumers across the state. During the investigation into the use of the Ingenix databases, the Attorney General has uncovered a trove of e-mails pointing to an egregious scheme by Excellus to defraud its members by using obsolete fee schedules to reimburse members for out-of-network care. The investigation has found that, for at least the past fifteen years, Excellus has used years-old fee schedules to reimburse consumers for out-of-network claims, saving itself countless dollars which should have been paid to consumers. Because medical costs rise substantially every year, the use of old fee schedules hurts consumers by paying them substantially less than they are owed. For every year by which the fee schedule is outdated, the harm to the consumer is compounded. For many years, Excellus has relied on pricing information that was as much as nine years old. Furthermore, emails and other internal communications secured by the Attorney General’s Office during the investigation show that Excellus employees were aware of their outdated rates and did nothing to correct the problem or pay members what they were owed. “In some of the most egregious evidence of fraud we have seen in this investigation, these emails reveal that not only did Excellus use outdated UCR fee schedules, but it made zero effort to fix the problem and pay members what they deserved. The company’s own internal communications show total disregard for the effect their skewed rates were having on hard-working families, especially across Upstate New York where Excellus controls the lion’s share of the health insurance market,” said Cuomo. According to a 2007 market report by the American Medical Association, Excellus controls 57 percent of the Rochester market for commercial health insurance and 66 percent of the PPO (“preferred provider organization”) market there; 42 percent of the Syracuse market for commercial health insurance and 97 percent of the HMO (“health maintenance organization”) market there; 27 percent of the Binghamton market for commercial health insurance and 80 percent of the HMO market there; and 15 percent of the Ithaca market for commercial health insurance and 100 percent of HMO market there. The Attorney General’s industry-wide investigation into rate manipulation began in February 2008, when Cuomo announced that he had issued subpoenas to the nation’s largest health insurance companies that use the Ingenix database, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield (NYSE: WLP). To date the investigation is ongoing. Jeff Kang, M.D., Chief Medical Officer for CIGNA, said: "CIGNA commends the Attorney General’s efforts to bring greater transparency to the pricing of health care services and we are pleased to partner in the creation of an independent not-for-profit organization to administer the new database. We recognize the Attorney General’s concern that there are inherent conflicts of interest related to the Ingenix database and expect that this new database will further enable people to make informed choices about their health care purchases.” Nancy Nielsen, M.D., President of the American Medical Association (AMA), said: “The American Medical Association commends CIGNA for committing today to the groundbreaking insurer settlements arranged by New York Attorney General Andrew Cuomo. In the wake of these agreements, the AMA calls upon all health insurers to reject the fatally flawed Ingenix database. Health insurers who truly recognize the importance of restoring their damaged relationships with patients and physicians should commit to the solution proposed by Attorney General Cuomo without delay.” Michael H. Rosenberg, MD, President of the Medical Society of the State of New York (MSSNY), said, “Attorney General Andrew Cuomo has taken another important step in propelling state and national healthcare reform and leveling the playing field with managed care organizations. Just a month after negotiating the first agreement, Attorney General Cuomo has managed to achieve what MSSNY and the AMA sought for more than eight years. With CIGNA joining United, Aetna, MVP, HealthNow and Independent Health - in abandoning the flawed Ingenix system - patients and physicians will now have the assurance of a viable and transparent reimbursement system for out-of-network services. At a time of great economic distress, this is a major step forward in the assurance of quality health care delivery.” Chuck Bell, Programs Director of Consumers Union, said: “Attorney General Cuomo's sweeping national investigation of the previously obscure Ingenix database has lifted the veil on this appalling financial rip-off, and created a new framework for a fair, consumer-friendly solution. Today's announcement shows that national insurers are coalescing behind a comprehensive, industry-wide strategy to reform the way that out-of-network charges are calculated, so consumers will be paid fairly.” The agreement announced today is the result of an investigation by Deputy Chief of the Health Care Bureau James E. Dering, Senior Trial Counsel Kathryn E. Diaz, and Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of Linda A. Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. In January, Cuomo also issued a report on his investigation, “Health Care Report: The Consumer Reimbursement System is Code Blue.” The report highlights the conflicts of interest and other defects in the current system and calls for the reforms announced today. To access the report, get consumer tips for out-of-network care, or to file a complaint, please visit http://www.oag.state.ny.us.

Late last week, the U.S. House and Senate approved the long-debated $787 billion economic stimulus package. Included in the final legislation, which is to be signed by President Obama this week, are the following items of interest to the chiropractic profession:

United Health Care used a faulty method to calculate risk costs and overcharged the state nearly $4 million for insuring the New York State Health Insurance Program (NYSHIP), according to an audit released today by State Comptroller Thomas P. DiNapoli. “United Health Care overcharged the state nearly $4 million,” DiNapoli said. “These days every dime counts and $4 million is a lot of taxpayer dimes. This practice must stop.” Civil Service Commissioner Nancy G. Groenwegen said, “This Department is constantly seeking ways to reduce premium costs to the State and local NYSHIP participants, and ultimately the taxpayers. We agree with the Comptroller and have begun negotiations with United Health Care to change the way it assesses and charges for the risks it undertakes.” New York State provides health insurance coverage to active and retired state, local government and school district employees. United Health Care is responsible for administering the medical/surgical and major medical portion of the Empire Plan, the primary health plan of NYSHIP. The New York State Department of Civil Service is responsible for overseeing the program. Auditors found that United Health Care was improperly calculating the amount it charged the state for insuring the risk associated with administering the Empire Plan. It is standard industry policy for insurance companies to charge employers for the risk of insuring their employees. United Health Care calculated its risk charge using gross premium costs rather than net, or actual, premium costs. For the last 20 years United Health Care has consistently overestimated gross premium payments the state must pay to cover anticipated costs and had to return money to the state. The three other insurance providers that administer the Empire Plan use actual costs to calculate the state’s risk charge. From 2004 to 2007, United Health Care charged the state $71.6 million for the risk associating with insuring the plan, which is $3.9 million more than if it had calculated the risk charge based on actual costs. Government Accountability The Office of the State Comptroller regularly audits state agencies, public authorities and New York City agencies. Auditors ensure that programs achieve their established goals, funds are used efficiently and assets are adequately protected against fraud, waste and abuse. DiNapoli’s office completes approximately 200 state audits annually and identifies hundreds of millions in savings and fraud each year. Click below for a copy of the audit.

NBCE HOSTS SIXTH ANNUAL STUDENT LEADERS LEADERSHIP FORUM Greeley, Colo.—The National Board of Chiropractic Examiners (NBCE) hosted 14 student leaders at the sixth annual student leadership forum on January 23, 2009. NBCE President Dr. Vernon Temple introduced students to an overview of the role of and the need for leaders to emerge at all professional levels in the chiropractic profession. Dr. Temple encouraged students to fill the important role of building unity and transparency within the chiropractic profession. He continued with a synopsis of the importance of trust, using important tenets from the book, At the Speed of Trust, which was given to each student at the end of their visit. Student leaders were given a complete overview and opportunities to ask questions concerning NBCE operations. Department overviews included: • Delphi studies, practice analysis, functions of test committees • Exams as a reflection of profession: Parts I and II reflect what is being taught; Parts III and IV reflect practice • Part III pilot testing • Part IV overview, including recent change in eligibility requirement • Test sites: security, role of TAs and ATAs, exam application processing, release of scores to state boards and examinee, test accommodations • International: worldwide growth, importance of standardized testing in helping profession gain worldwide credibility and acceptance, funding of chiropractic position at the World Health Organization • NBCE finances: budget development process, importance of forecasting future student enrollment, importance of restricted reserves, and funding agreement for the FCLB Attendees included: Student American Chiropractic Association (SACA) Officers: • Betsy Robinson, National Chair • Rachelle Mulford, National Vice Chair • Lance Cohen, National Legislative Chair • Daniel H. Bronstein, National Vice Legislative Chair American Black Chiropractic Association (ABCA) Representatives: • Micheala Edwards, National Student Representative • Norquita Johnson, Western Region Student Representative • Anthony Witherspoon, Southern Region Student Representative Student International Chiropractors Association (SICA) Representatives: • Clint Erickson, Congress Chair • Eva Sepulveda, Congress Vice-Chair • Stacy Land, Congress Secretary • Joanna Prokes, Congress Legislative Liaison World Congress of Chiropractic Students (WCCS) Representatives: • Ali Postles, Chair • Allison French, Regional Representative N. America West & Mexico • Sarah Hatherly, Regional Representative N. America East & Canada Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

MVP Health Care is First Upstate, Non-Profit Insurer to Sign Agreement with Cuomo AG Also Issues Five-Day Notice to File Suit Against CDPHP for Consumer Fraud Attorney General Andrew M. Cuomo today announced the expansion of his historic reform of the nationwide healthcare reimbursement system to Upstate New York. Cuomo has reached an agreement with the Schenectady-based insurer MVP Health Care, Inc. in his ongoing drive to eliminate the defective and conflict-of-interest ridden Ingenix database and generate fair, out-of-network reimbursement rates for patients. Cuomo also announced that he has filed a five-day notice to file suit against another Upstate health insurer, Capital District Physician’s Health Plan (CDPHP), for failure to embrace these reforms. MVP, a non-profit health insurer that covers over 700,000 patients across Upstate New York and the East Coast, did not contribute data to Ingenix, but, like other insurers across the country, relied on the database to determine reimbursement rates for patients who went out of network. Despite not being a contributor, MVP has proactively agreed to embrace Cuomo’s reform efforts and end its relationship with Ingenix, becoming an industry-wide leader in the fight to ensure fair reimbursement rates for working families nationwide. “Companies like MVP that proactively embrace reform are an essential part of our continued momentum towards change that is nationwide and industry-deep,” said Attorney General Cuomo. “I commend MVP for being a true industry leader and hope that their forward-thinking actions today encourage others to follow suit. If they do not, as my notice to CDPHP today makes clear, this Office will not hesitate to bring legal action against anyone who was involved with Ingenix.” Earlier this month, Attorney General Cuomo announced sweeping reforms to end the manipulation of reimbursement rates at the expense of patients across the country. After a months-long investigation revealed that the health insurance industry relied on a faulty database to set rates, Cuomo reached groundbreaking agreements with UnitedHealth Group Inc. (NYSE: UNH), the owner of the Ingenix database and the second-largest insurer in the country, along with Aetna (NYSE: AET), the nation’s third-largest insurer. Attorney General Cuomo’s investigation concerned allegations that as a subsidiary of a major health insurer, Ingenix had a vested interest in setting rates low, so companies could underpay patients for out-of-network services. The investigation revealed that the database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The establishment of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest. In early January, Attorney General Cuomo announced the first settlement in his investigation with UnitedHealth, under which the database of billing information operated by Ingenix will close. United also agreed to pay $50 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States. Cuomo has since reached an agreement with Aetna who will pay $20 million to the new database. Today’s agreement with MVP is the first involving a non-profit, upstate insurer and demonstrates the industry’s growing commitment to Cuomo’s reforms. Under the terms of the agreement: • MVP will cease using the Ingenix databases to calculate out-of-network reimbursement rates; • MVP will also amend their member disclosures to provide clearer information to its members about their method of determining reimbursement rates; • If MVP continues to promise its members that they will be reimbursed based on “usual and customary rates,” MVP will use the new database; • MVP will contribute $535,000 over a five-year period to help fund the new, independent database; • A nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database; • The nonprofit will develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area; • The nonprofit will make rate information from the database available to health insurers; • The nonprofit will use the new database to conduct academic research to help improve the health care system; • The nonprofit will be selected and announced at a future date Denise Gonick, MVP Health Care executive vice president and chief legal officer, said: “Like many other health insurers, MVP used the Ingenix database. We recognize the Attorney General’s concern about conflicts of interest inherent in the Ingenix database and appreciate his providing our industry with an independent process that is transparent and helps consumers make more informed health care purchasing decisions. MVP welcomes the opportunity to be the first upstate New York based health insurer to introduce this reform to our members, and believes that consumers and providers will be well-served by the joint effort that we are announcing today.” Dr. Nancy Nielsen, President of the American Medical Association, said: "We are encouraged that health insurers are stepping forward and recognizing the importance of restoring their damaged relationships with patients and physicians by committing to the creation of a new, independent database that will restore fair reimbursements. The American Medical Association commends MVP/Preferred Care for joining United Healthcare and Aetna by agreeing to the solution proposed by New York Attorney General Cuomo and calls upon other health insurers to do the same." Dr. Michael H. Rosenberg, President of the Medical Society of the State of New York, said: “Today’s announcement – that brings us another big step closer to achieving a major goal that the Medical Society of the State of New York and the American Medical Association have been working on since 2000. This agreement with MVP is particularly noteworthy because it will help to reduce the cost of out-of-network medical care for patients in this area, which has been impacted by the economic downturn. Efficient use of the healthcare dollar is particularly important to these New Yorkers today.” Chuck Bell, Programs Director for Consumers Union, said: “Attorney General Andrew Cuomo’s investigation of the health insurance industry has blown the cover on a massive, national problem in the out-of-network reimbursement system. Thanks to this investigation, we now know that many, many consumers are being grossly underpaid by their insurers when they go out of network to visit a physician or medical provider. We commend MVP Health Care for being an early leader in supporting a new independent nonprofit institute based in New York state that will collect and maintain data on out-of-network charges, and contributing half a million dollars to fund its work.” Cuomo also announced today that he has given CDPHP five-day notice of intent to sue for refusing to abandon the use of the Ingenix database and embrace reform. CDPHP is another non-profit insurer based in the Capital Region that insures 400,000 patients throughout 29 counties in New York State. The Attorney General’s five-day notice states that the Office intends to commence litigation against CDPHP in order to stop the unlawful acts and practices that they have engaged in and continue to engage in. It will also seek to obtain injunctive relief, restitution, damages, and civil penalties. The unlawful acts and practices complained of consist of engaging in repeated and persistent fraudulent, deceptive, and illegal business practices in connection with CDPHP’s continued use of the Ingenix databases for reimbursing members’ covered out-of-network services in New York State. The agreement announced today is the result of an investigation by Deputy Chief of the Health Care Bureau James E. Dering, Senior Trial Counsel Kathryn E. Diaz, and Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of Linda A. Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. Earlier this month, Cuomo also issued a report on his investigation, “Health Care Report: The Consumer Reimbursement System is Code Blue.” The report highlights the conflicts of interest and other defects in the current system and calls for the reforms announced today. To access the report, get consumer tips for out-of-network care, or to file a complaint, please visit:

The National Board of Chiropractic Examiners (NBCE) Board of Directors recently voted to help sponsor a position in chiropractic at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland. The position is the first chiropractic appointment ever established at the WHO and has been offered to Dr. Molly Meri Robinson as a mid-level technical officer, a non-treating physician. The NBCE joins the National Chiropractic Mutual Insurance Company, Foot Levelers, Standard Process and the World Federal of Chiropractic in financially supporting the first year of Dr. Robinson’s appointment. Dr. Robinson, a graduate of Northwestern Chiropractic College, previously served as National Legislative Chair for the Students of the American Chiropractic Association, as well as regional representative of the World Congress of Chiropractic Students. She was the first chiropractic intern to serve at the WHO, a position that resulted in the development of a permanent chiropractic position. NBCE President Dr. Vernon Temple announced the NBCE’s support, saying, “We are extremely proud of the dedication and prudent judgment shown by Dr. Robinson during her internship. The doors she has opened will help to lead the major paradigm shift currently taking place worldwide in chiropractic health care. Dr. Robinson’s presence in Geneva will serve as a constant reminder of the excellent education of chiropractors and their ability to serve as portal of entry physicians.” He said, “This is an excellent match for the NBCE as we develop the International Board of Chiropractic Examiner’s role in including chiropractic in national health care delivery systems.” The World Health Organization is the central clearinghouse for information on health care for 193 countries around the world. Because of the WHO’s importance in defining future health care policy, the NBCE Board of Directors chose to endorse and support the appointment of Dr. Robinson. She will represent the chiropractic profession in crafting policy that will consider non-pharmaceutical treatment, especially chiropractic, among treatment modalities. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. For more information, please contact Joanne Monath, Director of Professional Relations and Communications at [email protected] or 970-356-9100 ext 119.

Researchers at the Palmer Center for Chiropractic Research (PCCR) clinic facility, 741 Brady St., Davenport, on the campus of Palmer College of Chiropractic, are looking for more than 200 people with low back pain in the Quad-City community to participate in a unique study. It focuses on the relationship between back pain and possible abnormal function of the supportive muscles in the back. The study begins Jan. 12. Participants must have low back pain and be between 21 and 65 years of age. This collaborative study between the Palmer Center for Chiropractic Research and the University of Iowa is one of three projects that are part of a four-year, $3.7 million grant from the National Institutes of Health National Center for Complementary and Alternative Medicine. This four-year grant was awarded to Principal Investigator Joel Pickar, D.C., Ph.D., at the Palmer Center for Chiropractic Research in 2007 to continue Palmer’s Developmental Center to Study Mechanisms and Effects of Chiropractic Manipulation. The clinical study beginning on Jan. 12 will help researchers determine whether one effect of chiropractic adjustments is a positive impact on muscle function in the low back. "We know that the back muscles are very important for movement and stability of the spine," said Palmer Vice Chancellor for Research and Health Policy Christine Goertz Choate, D.C., Ph.D., who is a co-leader for this study. "When people have back pain, it may be caused by problems in the muscles that attach to the vertebra and support the spine. We’re investigating how well people with back pain can control their muscles and whether chiropractic care can have an effect on muscle function. This work will eventually help us understand more about how chiropractic treatments work and ultimately lead to improved care for low back pain" According to the project’s other co-leader, David Wilder, Ph.D., Associate Professor of Biomedical Engineering at the University of Iowa, "Anyone who has been surprised by back pain resulting from unexpectedly stepping off a curb or from trying to pick up a squirming child in the back seat of a car understands the importance of proper muscle function." Dr. Wilder has collaborated with the PCCR for fourteen years, is a faculty member at Palmer and brings to the project thirty years of experience studying the response of the spine and trunk muscles to sitting, vibration and sudden loads. Potential participants will be examined at the PCCR clinic to determine whether they qualify for the study. If so, they will be randomly assigned to one of three different treatment groups. Members of each group will receive chiropractic care using three different adjusting techniques over a six-week period. At the beginning, middle and end of care, specialized measurements of body stability and muscle control will be taken. All examinations and treatment are provided at no charge to the patient. Anyone interested in participating in the study should contact the PCCR clinic facility at (563) 884-5188.