Allegation of Complaint:
Paul Benidict Schirmer, D.C.; License # 0104556352
Nature of Complaint:
The chiropractor from approximately November 2007 through June 2008 billed Anthem Blue Cross and Blue Shield-Federal Employee Program for multiple chiropractic services that neither the chiropractor or his employees adequately documented as being provided to Patients, A, B, C, and D.
The chiropractor denied billing for services that were not provided to patients, however, failed to demonstrate in his records where such treatments were documented to include physical exam, rationale for treatment, equipment settings, treatment location, and patient response to treatment provided.
The chiropractor from approximately November 2007 to June 2008 failed to properly manage the care and treatment of Patients, A, B, C, and D. The chiropractor failed to develop and document that he established a comprehensive treatment plan with specific objectives for Patients A, B, and C, and failed to obtain and document an adequate and complete health history for Patients A, C, and D.
The chiropractor failed to properly manage and maintain accurate, complete, legible, and timely records for Patients A, B, C, and D.
The chiropractor stated that he has contracted with a chiropractic billing/documentation consultant to audit his practice and train staff in proper billing methods. The consultant plans to review the chiropractor's practice on a monthly basis. The consultant recommended that the chiropractor obtain the services of a billing/coding specilist for his practice and the chiropractor has contacted a coding specialist to provide services for his practice.
The chiropractor shall pay a monetary penalty in the amount of $2,000.00 to the Virginia Board of Medicine within forty-five days. The chiropractor has been issued a Reprimand and his license shall be subject to the following terms and conditions:
- The chiropractor within six months shall submit satisfactory proof to the board that the chiropractor has completed fifteen hours of board approved continuing medical education in medical recordkeeping and documentation.
- The chiropractor shall ensure that quarterly reports from any and all chiropractic billing/coding/documentation consultant(s) regarding changes made by the chiropractor in his office billing practices in accordance with the consultant's recommendations are submitted to the board.
- The chiropractor shall ensure that the consultant(s) submit a list of patient charts/billing records that the consultant(s) has reviewed and certifies that all billing was done in accordance with insurance billing requirements.
- The Department of Health Professions inspector/investigator within six months following the physician's completion of the required continuing medical education shall obtain and copy a random sample of ten of the chiropractor's patient records/billing records for review by the board.