My name is David Luther, and I would like to offer my apologies for not being a more prolific writer. I know many of you have been confused about my intentions in regard to the massage profession. Hopefully, I can set the record straight and dispel some of the misinformation. I am an owner of The Medical Massage Office & Associates (TMMO), a for-profit company. I also currently own the Medical Massage National Certification Board (MMNCB), a for-profit company. I do not own the United States Medical Massage Association (USMMA), which is a not-for-profit membership association; however, I am USMMA's founder and current president, and I did provide the initial financial endowment.

This letter is not directed to every therapist. There are many therapists doing great work. Keep it up, and if there is anything I can do to support you, let me know. This letter is directed to those who do not know what they are doing and have no business billing insurance. To those of you who have found an easy way to make a quick buck and haven't done a thing to understand what quality clinical skills are, this letter is for you and about you.

TMMO is a group of educators that offer advanced training in medical massage. During my 30 years in this industry, I found that I have had some shortcomings in my clinical skills. About 12 years ago, I stumbled into insurance reimbursement and found that it was perfect for me. I could make a better living and feel a whole lot more secure. I was very fortunate that I found a chiropractor to send me referrals, and I went to work. I poured my heart and soul into the care. I believed I was doing great work, and I thought I knew everything I needed to know to help my patients. My patients told me that I was "great" and "the best they had ever had." They even called me a "healer." Well, I believed them.

I was living in Ft. Lauderdale, Fla., at the time and my next-door neighbor was a physical therapist. One day, I was sharing my success with him and we began chatting about what I do. Wow, that was scary. I could barely understand him. Everything he said was over my head. He was a friend and tried to enlighten me, and I asked if he could "dummy it down" so I could learn. He did and I started to learn how much I didn't know. Unfortunately, I moved away and I frequently wished I could find that type of help again. Years went by, circumstances changed, and I began writing and teaching others how to bill insurance. I was proud of my new fortune. I sold insurance billing manuals and taught thousands of therapists how to work within the system. I have taken tens of thousands of phone calls from therapists seeking help. I guess you could say I've been a major player in this arena. About three years ago, I got a call from a physical therapist that had become a massage therapist and wanted to ask a few insurance questions. I was intrigued by his love for massage so I started asking him questions about how being a PT helped him be a better massage therapist. Wow again. It was like déjà vue. To make a long story short, I talked to him for days. Of course, I had to ask him to "dummy it down" so I could learn. I asked him to tell me what massage therapists were missing in their education and found that the most profound absences were in orthopedic assessment, pathology, protocols, medical terminology, medical ethics and documentation. So, I asked him to show me - another wow, a third time. If I could only sound that professional, write that professionally, and treat patients with that much understanding, I could change my patients' outcomes. Understand one thing, I was making a great living writing and selling my insurance billing manual and software, and teaching my seminars. I didn't need any other responsibilities' but I wanted so badly to share this with others. Financially, it was a huge mistake. Spiritually, it was the right choice.

I tell you these things because I believe that I (and others like me) have a moral responsibility. I could go on teaching insurance billing and have a financially bright future. I could continue wanting everybody to buy my book, software and seminars. I would have less grief and a whole lot more money. But I've grown to believe that would be unethical. I have taught hundreds of massage therapists who have not furthered their knowledge and are billing insurance only because it pays great. Therapists who have no massage training at all or only have 100 hours of training. I could go on and on about those who are ripping off the system. Their argument is that all massage is therapeutic. Remember how many times you have complained about other skill levels? Not all massage therapists are therapeutic; not all therapists billing insurance are ethical. If it were only a few, I would probably leave it alone, but it's not. There are too many. Those of us who have taught them know they are giving us a bad name. If we don't set a standard for clinical work, we are doing the ones that have really worked to get here the biggest injustice.

People have made accusations about me owning TMMO and MMNCB and being the president of the USMMA. That is all true. No one else was willing to stand up and take the responsibility and challenge, so I did. The American Massage Therapy Association (AMTA) wasn't interested. They told me that less than 2 percent of their constituents had anything to do with insurance, and they had no interest in getting involved. The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) told me that insurance and medical massage wasn't their focus and that they had set the standard for entry-level massage only. No one wanted to help establish a standard, yet many said it needed to be done. This has not been easy or fun - being a pioneer never is. Someone once said to me, "You know how you can identify a pioneer? By the arrows in their back."

What is interesting to me is that most of the people fighting in this movement are those who have nothing to do with medical massage. We do not wish to control or even adversely affect them. We just want to stop anyone from fraudulently billing insurance. If the critics have a better way of stopping the fraud, stand up and contribute. If you think there is no fraud being perpetuated, get your head out of the sand. I do not want to hurt, stop or interfere with any of you that are legitimately, ethically and morally providing quality service, and I hope you would agree. If you don't see the need to prevent fraud, you are either seriously unaware or you are one of the abusers I'm referring to.

The Medical Massage National Certification Board: I own it and every penny that was put into its development came out of my pocket. I have had little to do with its actual development. This test has had many contributors and all of the TMMO associates have given tirelessly to test questions. So have many others. The call was put out to as many leaders and educators as could be identified. Committees have been established to help in all aspects of its development. My role was more as the financial investor. Yes, I would like to receive a return on my investment, but that day is in the future. Any of you critics want to lend a hand financially or as part of a committee? I didn't think so. My phone does not ring with calls offering to provide assistance. I doubt that you are willing to provide the financial support or the kind of time required to make change. We have been looking for a qualified group of investors to take over the MMNCB. My representatives have spoken to several investors over the last several months. None of those currently interested has any background in massage. If my only interest were financial gain, I would take their offer and move on. I am still hoping to find someone within this profession who believes as I do and shares my passion for protecting the respect we have already achieved while increasing our availability to those who cannot afford to avail themselves of our expertise outside of insurance reimbursement.

The United States Medical Massage Association: Yes, I'm the founder and current president. Elections are this fall, and I am hoping someone with great leadership abilities and knowledge of the legal issues will fill my spot. I am not seeking another term. The USMMA is a not-for-profit corporation and is just finishing the 501(3)(C) requirements for tax-exempt status. Anyone who thinks I would take any money from this organization is uninformed. That would be a felony, and I have no intention of going to jail for anything. I am a full-time volunteer for this association. Anyone want to stand up and lead for free? I didn't think so.

If you want to criticize my motives, I suggest you walk a mile in my shoes first. I see and hear a lot of opinions, but I don't see any leaders standing up or putting up their own money to make a difference. If you don't see the fraud it must be because you're not really involved. If you don't care that others are wrecking this for us, you're not really involved. If you do care, get involved. We could really use your help. My suspicion is that those who are fighting the hardest are the very ones I want to stop. The committees of the MMNCB have done a great job developing the Medical Massage National Certification Examination; if you know your stuff you will have no problem passing it. So far, over 95 percent who have taken the exam have passed it. You do not need to take any specific seminar or classes to sit for the exam. Having that little piece of paper could be worth its weight in gold. Don't be afraid of it. Embrace it - you earned it. There are massage therapists out there with only 100 hours of training. Are you going to argue that they have the competency to handle dysfunctions like TMJ, thoracic outlet syndrome, carpal tunnel, frozen shoulder, lumbo-sacral radiculitis, fibromyalgia and whiplash with only 100 hours of training and a manual or seminar on insurance billing? They're out there, and they're billing insurance. Is that fair to you? They think so. I don't and you shouldn't. I hope you will understand the importance of what I'm doing and will join in and help. Thanks to so many of you that have joined in already. Your kind words and the trust you have given keep me on track.

For those of you who badly misquote the facts, distort the truth and continue to insist I'm doing this for the money, I implore you to check your facts. I have scanned and posted the corporate documents of the USMMA in an attempt to correct some of the misinformation and accusations. Who does that? What other organizations are even asked to do that? Yet, I continue to be accused of running an association for-profit. People continue to write letters and posts that contain inaccurate information that can easily be researched. What is their purpose? I have not and am not getting the money they keep accusing me of getting. I invite anyone to seek proof to the contrary. If you would like and you are seriously interested in the future of medical massage, you are invited to come audit my books and try to prove I'm doing this for greed. There are a few people who have done just that. I find it disturbing and exhausting that I am constantly required to spend time addressing inaccurate information related to me personally or to my motives. These accusations do not come from people who need help with insurance billing questions or denials of payment. The misinformation doesn't come from people who want to learn how to earn the respect of the medical professionals in their community.

Please do not misunderstand. I have no desire to argue medical massage with someone performing chair massage in a corporate lobby for $1 per minute. I support that work and I believe in the benefits. I even believe you might be able to document improved productivity. But that same individual is not necessarily qualified to work on an employee who was in a car accident last week, especially if the massage education was obtained in a non-licensed state and the therapist is working in a community without regulation. My focus has been interrupted and my passion for this profession has been diluted enough. I have addressed these issues here for the sake of those who may honestly be misguided and misdirected by the murky waters. I urge you to check your information. Ask your own questions. I have been encouraged and challenged by many therapists who are providing massage to patients referred by medical doctors (medical massage) to narrow and redirect my focus. There are therapists all over this nation who have a desire to work alongside medical professionals. They have an honorable desire to be available to communities of injured workers that cannot afford to pay cash for two to three treatments a week for four to six weeks. These dedicated professionals run into problems with insurance reimbursement from time to time. These are the battles I am willing to fight. Join me.

One closing thought. With all the controversy going on, the AMTA has never tried to dialog with the USMMA or with me. Cliff Korn has never tried to dialog with me; Whitney Lowe, be careful of your facts. From those very same committee members we have stacks of e-mail contradicting your allegations [See Cliff Korn's July editorial, "'Using' Medical Massage," www.massagetoday.com/archives/2005/07/11.html]. I dare you to dialog with me. My mother always said, "You have a problem with someone, you need to confront that someone." Cheap shots and poor investigation only makes you look foolish.