Chiropractor Faces Professional License Investigation from Board
A chiropractor from Ohio has been charged with healthcare fraud for overbilling insurance companies for his services, and could face an investigation into his professional license by the Ohio State Chiropractic Board.
Jeffrey R. Shope, 44 years old, faces charges that he overbilled insurance companies through his company, True Health Practice, between 2009 and 2012. Allegedly, the healthcare fraud landed him $696,373. Not only did he overbill for services, Shope allegedly billed insurance companies for non-reimbursable services, services which were not provided to patients, or services which were not fully provided. He also reportedly double billed for several services during the 4 year period.
If found guilty of the healthcare fraud charges, Shoped could face up to 10 years in prison, and a $250,000 fine. He also stands to undergo a professional license investigation – although the Ohio State Chiropractic Board has not decided if they will investigate him or not – while he also defends himself against the criminal charges.
Shope is reportedly expected to plead guilty to the healthcare fraud charges at a U.S. District Court in Columbus on September 29th. If he pleads guilty to the felony healthcare fraud charges, Ohio state professional licensing law will automatically trigger disciplinary action through the chiropractic board, which could include revoking his professional license to practice, and specific disciplinary steps to earn the license back when he is released from prison.
This is not, according to the chiropractic board, the first time that Shope has faced fraud charges and lost his license. In 1999, he was accused of misleading advertising, falsifying patient records, fraudulent conduct, and other types of fraud while he worked at Westerville Health Care – a company with the same address as his current company, True Health Practice. His professional license to practice was suspended for a year, and Shoped was on probation until 2006.
To regain his professional license for chiropractic work, Shope was required to take 48 hours of instruction on medical ethics, billing, financial management, and other topics related to his healthcare practice. He also had a compliance officer with the chiropractic board monitor his office during his probationary period.
In South Carolina, the licensing board may revoke a professional chiropractic license if “any false, fraudulent or forged statement has been used, or any fraudulent, deceitful or dishonest act has been practiced by the holder of a license in connection with any of the licensing requirements.” An investigation into potential fraud could be triggered if a current or former patient complains to the licensing board, and claims that the licensee has committed healthcare fraud of some kind – for example, over-billing insurance or forcing the patient to pay for services that should be covered by insurance. This could be a simple misunderstanding that gets escalated to an investigation, or it could be something more serious.
In addition, if a chiropractic license holder in South Carolina “has violated the code of ethics or regulations as adopted by the State Board of Chiropractic Examiners,” then the license could be revoked. This includes many types of crime, from alleged healthcare fraud to DUI, that could trigger an investigation and the revocation of the professional license.