FROM:                Bureau of Occupational Licenses 

                SUBJECT:          Complaint Investigation Report 

FY 2005: To date, thirteen (13) complaints have been received. Of those, twelve (12) are under investigation, and one (1) has been referred for administrative action.

FY 2004: Twenty-two (22) complaints were received. Of those, six (6) have been closed; five (5) were referred for administrative action; eight (8) remain under investigation or pro-review; and three (3) await Board determination.   

CHI-P5B-2-2004-3            C alleged R inappropriately billed for services, charged excessive interest, charged for services not provided, failed to write off amounts disallowed by insurance, charged different fees to different insurance companies, and failed to apply payments to account. R denied allegations and provided records and statements that supported appropriate procedures. INV did not reveal evidence to support the allegations or violations of law or rule. Pro-review concluded that, while no violations occurred, R should probably be advised to not to charge interest when there is a question about billings, and that R should keep more legible daily notes. 
IBOL recommends the Board authorize closure with an advisory letter noting the above, and a recommendation that R refund any balance due or refund overpayments due to interest charges.

CHI-P5B-2-2004-12            C alleged R repeatedly sent a patient to a DAY SPA for massage, and submitted billings to insurance indicating that treatment was provided in R's office. INV revealed that massage therapy was provided in R's Day Spa by a massage therapist and that billings were accurate. Though the insurance carriers appear to be unsure of billing requirements and procedures, the INV revealed no violations.
IBOL recommends Board authorize closure.

CHI-P5B-2-2004-16            C alleged R performed excessive treatments, after C advised R that the condition was improving. C also alleged R convinced C to lie about the level of pain for insurance billing purposes. INV revealed the matter had also gone through the Peer review process. INV revealed that R's treatments and billings were well documented. R denied performing unnecessary treatment and encouraging C to lie about condition. R noted that the records indicated C may have been untruthful about pain levels. C admitted to the INV of being untruthful to R about pain levels. INV did not reveal evidence to support the allegations or of violations to law or rule. IBOL recommends the Board authorize closure.

Last Modified - July 26, 2006