Article - April 17, 2008 - Snoqualmie Valley Record

Chiropractor complaint remains on square one

By Seth Truscott

The Washington State Department of Health's disciplinary action against North Bend chiropractor Greg Pfiffner is still on square one.

The department's Health Professions Quality Assurance Office recently amended its statement of charges against Pfiffner, which include allegations of improper billing and having sexual relationships with patients.

In 2007, the department began looking into allegations against Pfiffner of professional misconduct in violation of state law governing medical practitioners. The charges are not criminal, but he could face sanctions including counseling, training or limitations on his practice if the allegations are confirmed.

Pfiffner's case was originally scheduled to be heard by the Department of Health's Chiropractic Commission on March 13.

But in February, the commission amended the statement of charges against him. In effect, that starts the timeline over for the hearing process, said Tammy Kelley, disciplinary program manager for DOH.

No new hearing date has been set, but it could happen as soon as September, according to Kelley.

The Chiropractic Commission is made up of licensed chiropractors and members of the public. One panel of the commission makes the allegations, while another panel, whose members are not familiar with the case, act as a jury. They hear the facts of the case, as presented by the state attorney general's office, who represents the department of health in a prosecutor's role. Usually, the defense is spoken for by the health care provider's attorney.

New details
The new amendments in the state's complaint state what sort of billing problems the department is concerned about.

Previously, the state's complaint alleged simply that Pfiffner routinely used an inaccurate or misleading billing code between June and December of 2005. The newly amended charge spells out those allegations, stating that Pfiffner used an inaccurate or misleading billing code to be paid for whirlpool services, at a time when he did not have a whirlpool. A separate item states that he used inaccurate or misleading codes to be paid for massages.

Pfiffner and his business consultant, Mary Stone, counter the state's allegations. They told the Valley Record that he's had a water therapy unit, which uses hot jets of water to help patients, since 2000.

"There are no patients or insurers who claimed that Greg billed without treating," she said.

The problem, Stone said, lies in the way that insurers ask physicians to use codes for billing.

"One insurer, out of the hundred-plus Greg bills, wanted him to use a different code than he had been using," Stone told the Record. "That insurer did not ask for repayment. No other insurer asked for a different code to be used."

"This whole thing is at the heart of the so-called health care crisis," Stone said. "In this case, when the insurance company identified one code that was being used instead of another, they said we want you to use another code because we don't want to pay for this treatment."

But that code doesn't describe what the way the Pfiffner uses the hydrotherapy bed.
"It's a catch-22," Stone said. "Greg's objective is to help the patient."

He still uses the hydrotherapy unit, but he never bills for it and is not paid for providing this treatment, Stone added.

"What's disappointing about that is the way the state has worded this implies that he charged for something he didn't have, and therefore didn't provide the service," Stone said. "That is not true. The service was provided, was billed for, but it's a coding issue, not a question of whether a service was provided."

The massage billing problem, she said, had to do with a tax ID number in the wrong space on certain forms.

The problem was rectified immediately, and Pfiffner is still credentialed with that insurance company.

"This problem was an isolated data entry issue that affected a small number of insurance company bills, and did not affect patient bills at all," Stone stated.

The discrepancies, she added, represent 0.01 percent of Pfiffner's revenues.

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