The Herald, Sharon, Pa.

Local News

October 16, 2006

Highmark: Chiropractor is on ‘fishing expedition’

By Joe Pinchot

HERMITAGE — According to health care provider Highmark Inc., a former local chiropractor is on a “fishing expedition” in his request for thousands of documents.

The company is asking a federal judge to quash the subpoena, or issue a protective order that will specify how sensitive information will be handled.

U.S. District Court Judge Joy Flowers Conti, Pittsburgh, set a hearing for Wednesday.

Detelich, 36, of Clearwater, Fla., formerly of Detelich Chiropractic and Advanced Medical and Holistic of Hermitage, both of Hermitage, has been indicted on charges of health care fraud and mail fraud.

Detelich filed claims with insurance companies for services that were not performed or were overstated, according to the indictment handed down Nov. 3.

He also made agreements with patients to file false claims and split the money with him, and failed to bill patients for co-pays, which he was required to do by the insurance companies, the indictment says.

Attorney Kenneth S. Kornacki, Pittsburgh, who represents Highmark, said Detelich wants a variety of information from a seven-year period about Highmark billing codes, including correspondence between Highmark and others concerning certain billing codes, a list of chiropractors denied payments for certain codes, and a list of claims, including patients’ names and medical documentation, that included certain codes.

Kornacki claims Detelich is on a “fishing expedition,” looking for more than just admissible evidence, and is asking Highmark to violate the federal Health Insurance Portability and Accountability Act by releasing certain patient information without a court order.

The company would have to review hundreds of thousands of documents, many of which are on microfilm or some other imaging storage source, to meet the request of the subpoena, he said. There is no electronic database to search for the records, so each would have to be retrieved and reviewed by hand.

“Considering that the subpoena requests documents for a seven-year period, Highmark conservatively estimates that it would have to expend no less than 120,000 man hours (at eight minutes of review per claim, letter, etc.) to comply with the subpoena,” Kornacki said. “Clearly, the demands of this overbroad subpoena are oppressive and burdensome.”

Detelich’s attorney, Robert J. Ridge, Pittsburgh, said there was confusion among chiropractors and doctors about the billing codes, and that Highmark tried to resolve the confusion through training, but the training provided incorrect information.

Highmark is the only entity that has the information Detelich needs that “may reveal confusion by other providers,” he said.

“The defendant cannot adequately prepare his defense without this information,” Ridge said. “The core of Dr. Detelich’s defense is that the codes billed are ambiguous and confusing and, therefore, the government cannot establish the required criminal intent.”

Ridge added he believed the information he is seeking is available through an easily searchable computer database.

“Considering that Highmark is the alleged victim in this case and has provided the government with information spanning seven years resulting in the indictment of Dr. Detelich, Highmark’s inconvenience in obtaining the information sought is subordinate to Dr. Detelich’s interest in adequately preparing his defense,” Ridge said.

Concerning HIPAA, Ridge said the only information containing patient names he is seeking are claims Detelich filed, and the payer and provider are allowed to exchange payment information without the patient’s OK.

Detelich altered his request for other patient information to be given without identifying patients.

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