resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
September, 2011, Vol. 11, Issue 09
Massage Therapy Insurer Pleads Guilty to Fraud
By Kathryn Feather, Senior Associate Editor
Bret T. Van Leeuwen, 52, the former president and founder of Stratus Insurance Services, Inc., pled guilty in June to one count of insurance fraud in the second degree. He agreed to pay up to $995,000 in civil penalties.
Three associations listed as victims in Van Leeuwen's plea include the now defunct IMA Group, the Hands-On Trade Association and the International Association of Reike Professionals. Massage Today readers might remember that Van Leeuwen and Stratus Insurance were linked in the financial demise of the International Massage Association and had accused owner and founder Will Green of owing Stratus "close to seven figures" and offered that as the reason Stratus dropped coverage of the IMA. However, Green claimed that Stratus had failed to properly acquire policies in several of the years since 2004, and alluded to an FBI investigation in a letter to IMA members in July of 2010. As reported in Massage Today in August of 2010, Van Leeuwen strongly denied Green's claims.
The Hands-On Trade Association (HOTA) became aware there was a problem with Stratus and Van Leeuwen in May 2010, when the case became public. Directed by Judi Calvert, co-founder of Massage Magazine, the HOTA formally terminated their relationship with Stratus and Bret Van Leeuwen in January 2011. According to Calvert, "it took time to transition to our new risk purchasing group, the Wellness and Beauty Association Risk Purchasing Group."
"Numerous issues with the company led us to start seeking a new risk purchasing group in May of 2010," said Calvert. "We are still in the process of determining the consequences. As owner of HOTA, I have given years of service to this wonderful industry, and it's important that our members know they can continue to trust us as their benefits provider. Our focus remains on serving our membership and the industry." As part of this new Wellness and Beauty Association Risk Purchasing Group, the HOTA is now with Western States Insurance.
Investigation Background And Timeline
In his Statement of Offense filed with the U.S. District Court for the District of Columbia on June 20, 2011, Van Leeuwen acknowledged he was the founder, president and majority owner of Stratus Insurance Services, which focused on specialty insurance programs provided to associations and purchasing groups. The three associations offered their members insurance coverage through a non-profit entity known as the Health and Beauty Risk Purchasing Group (HBRPG), which Will Green of the IMA was also involved in starting.
Van Leeuwen's partner in providing these policies was Rodney R. Ayer, former president of Phoenix Underwriting Managers Inc. According to prosecutors, Ayer pleaded guilty in July 2010 to one count of insurance fraud in connection with fraudulent statements in a 2006 application to operate as a captive insurance company in Washington, D.C. Ayer agreed to pay $500,000 in penalties and set aside an additional $495,000 in an escrow account to cover any outstanding claims for the policy periods covered by the criminal charges, which cover September 2004 through May 2006.
Mark Maxson, Senior Vice President at Willis Re, and an insurance industry expert, said the escrow fund might not be sufficient if major claims are filed for that time frame, "in this case, $500,000 to cover all claims for a portfolio of exposure--particularly when the portfolio consists of 15,000 policies. Even one policy limits claim would wipe out the fund and leave all the other insureds unportected."
"We became aware of the Ayer case in July 2010 through Massage Today," said Calvert. "Prior to that, we didn't know that we were named in the Ayer case."
Van Leeuwen admitted that he and Ayer intended to insure the members of the HBRPG which included the IMA and the HOTA, as well as the approximately 27,000 members of the Federal Employee Professional Liability Insurance Program, with insurance carriers known as "cells" which would be established through multi-national insurance carrier, Hannover Rueckverisherung AG (Hannover Re). Van Leeuwen and Ayer planned to co-own the cells, which would be associated with Hannover Re, and supervise the administration of the HBRPG, as well as the Federal group. Based on their knowledge of the claims histories for both groups, Ayer and Van Leeuwen expected substantial underwriting profits from owning and operating these programs. However, both men did not reveal their ownership of the cells to the associations participating in the HBRPG.
Van Leeuwen and Ayer did pay the claims associated with these programs and they did retain the underwriting profits associated with these groups. However, there was just one problem with this arrangement; Hannover Re backed out of its coverage of the programs in December 2005. Despite Ayer and Van Leeuwen being unable to obtain approval from Hannover Re to operate the cells, the men led the associations and insurance regulatory agencies to believe that Hannover Re had approved the cells to insure the Federal program and the HBRPG.
According to court records, while continuing to pay claims and receiving substantial premium payments from members of both groups based on representations that Hannover Re was insuring those programs, Van Leeuwen and Ayer filed an application with the District of Columbia's Department of Insurance, Securities and Banking in April 2006, seeking approval for a District of Columbia Certificate of Authority allowing Defense Shield Insurance Co. Inc. (DISC) to operate as a captive. The DISC was intended to succeed the cell Ayer and Van Leeuwen led the associations to believe was being handled by Hannover Re.
Chris Van Leeuwen, brother of Bret Van Leeuwen and current President of Stratus, said the company does continue to provide massage therapy insurance. He said the guilty plea does not impact any of the coverage it currently provides to massage therapists and there was no lapse in coverage for those programs under the Beauty, Health and Trade Alliance Purchasing Group. Stratus Insurance covers approximately ten different groups through the Beauty, Health and Trade Alliance Purchasing Group.
Rodney Ayer has not yet been sentenced. Bret Van Leeuwen is scheduled to be formally sentenced on September 26, 2011. He faces a maximum sentence of 24 months in prison, a fine of $10,000, a three-year term of supervised release and a $250 special assessment for the Crime Victim's Assistance Fund, in addition to his civil penalties of almost $1 million.
In the meantime, the organizations involved are left to pick up the pieces and try to move on. "We're focusing on the future," said Calvert. "We feel that our decision to go with another risk purchasing group best serves our members needs."
It remains unclear what the status of coverage is for those insured through any of these groups in the years 2006-2010.
However, it looks as though this case isn't over just yet. Bill Miller from the U.S. Attorney's Office would only say that "we typically do not comment on cases that are still active. Because the case is pending and remains under investigation, the U.S. Attorney's Office is unable to comment at this time beyond relying on the public record of what is said or submitted in court."
Massage Today will continue to monitor this case as the U.S. Attorney's Office investigation continues.
Editor's Note: As this issue of Massage Today was going to press, MPA Media received a letter from attorneys representing a massage therapy insurer that has had a relationship with Stratus Insurance, but which was not mentioned or included in the 2004-06 insurance fraud case. On August 2, 2011, Eric Hearn, a lawyer representing The Doyle Group, owners of Massage Magazine and Massage Magazine Insurance Plus (MMIP), stated that "Doyle has terminated its contractual relationship with Stratus." The letter warned of legal action should this story "implicate Doyle in the affairs that culminated in Bret Van Leeuwen's current legal issues." At the time the letter was sent, Massage Today had made no contact with The Doyle Group. Massage Today then contacted The Doyle Group to ask when and why the relationship with Stratus Insurance Services was officially terminated but received no response.
A publicly available May 16, 2010 record (approximately two months before Ayer's guilty plea) of the MMIP website contains this language: "MMIP is offered in conjunction with Stratus Insurance Services, Inc. American Fork, Utah. Coverage under the MMIP program is underwritten by certain underwriters at Lloyds, London, an A rated carrier." A screenshot of the same website taken on July 25, 2011, has language stating that "MMIP is offered in conjunction with the Beauty, Health, and Trade Alliance Purchasing Group, domiciled in IL and Stratus Insurance Services". Upon receipt of Hearn's August 2 letter, a review of the MMIP webpage showed that the reference to Stratus was removed, consistent with the attorney's letter stating that contractual relations with Stratus had been terminated. The Lloyds of London reference remained.
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