In 2011, the Minnesota Board of Chiropractic Examiners disciplined Jeffrey M. Styba, D.C. for improperly enrolling patients into credit card plans, overbilling them, ordering unnecessary services, and failing to keep adequate records. The stipulation and order (shown below) indicates that:
- When enrolling patients in a CareCredit plan, Styba or a staff member would complete the application form online and routinely claim an annual income at or above $120,000. Rather than inquiring about the patient’s income, he or his staff would just “plug in a number.”
- In many cases, Styba failed to obtain the patient’ signature, provide credit card vouchers, obtain signatures to indicate that the patient received and understood the payment options, billed for services not documented as performed, billed for services at higher rates than warranted, billed for one-on-one exercises even while monitoring more than one patient at a time, failed failed to document that payments received were credited to the patients’ accounts,
- Styba ordered identical x-ray views on most patients regardless of the presenting complaints or symptoms and sometimes failed to obtain views of the area of interest.
- Styba’s treatment plans were the same for patients regardless of their initial complaints or findings.
- Styba’s clinical notes often were copies of the same note containing repeated phrases and typographical errors copied and repeated over and over for extended periods of time,
The board assessed a $30,000 administrative penalty (to be paid in monthly installments) and suspended Styba’s license for 18 months, but stayed the suspension if he corrected his improper practices, completed ten hours of continuing education in health care documentation, and passed an examination in ethics and boundaries. A few months later, however, when the board learned that he did not take the course, failed the examination, and made only one payment, the board made the suspension indefinite and, in 2014, canceled his license. Records from the Texas Board of Chiropractic Examiners indicate that in 2013, Styba was represented in a YouTube video as an associate of Elevation Health, a chain of chiropractic clinics co-founded by two Texas chiropractors—Jimmy Labrecque, D.C. and Rob Vasquez, D.C.—each of whom was reprimanded for “professionally associating with a person whom he knew to have a suspended license.” Styba is now hawking dōTERRA essential oils.
BEFORE THE MINNESOTA
BOARD OF CHIROPRACTIC EXAMINERS
In the Matter of
JEFFREY MICHAEL STYBA, D.C.
License No. 4899
Jeffrey M. Styba, DC (“Respondent”), and the Minnesota Board of Chiropractic Examiners Complaint Panel (“Panel”) agree the above-referenced matter may be resolved without trial of any issue or fact as follows:
A. The Minnesota Board of Chiropractic Examiners (“Board”) is authorized pursuant to Minnesota Statutes sections 148.01 to 148.108 to license and regulate chiropractors and to take disciplinary action as appropriate.
B. Respondent holds a license from the Board to practice chiropractic in the State of Minnesota and is subject to the jurisdiction of the Board with respect to the matters referred to in this Stipulation and Order.
On February 24, 2011, Respondent and his attorney, Todd A. Crabtree, Crabtree Law Firm, Stillwater Minnesota, appeared before the Panel to discuss allegations contained in a Notice of Conference dated January 11, 2011. Careen Martin, Assistant Attorney General, represented the Panel at the conference.
The parties agree this Stipulation and Order is based upon the following facts:
1. Respondent was granted a license by the Minnesota Board of Chiropractic Examiners on January 1, 2007.
2. Respondent owns and operates Exodus Chiropractic, Blaine, Minnesota and has done so since April 2007. Respondent provides chiropractic services at Exodus Chiropractic.
3. GE Money Bank is a financial institution that offers the CareCredit credit card, which it describes as a “healthcare credit card that can be used as a payment option for certain expenses not covered by insurance or to bridge situations when desired care exceeds insurance coverage.”
4. Beginning in 2007, Respondent offered patients the option of paying for chiropractic services with a CareCredit credit card. Respondent would facilitate a patient’s application for a CareCredit credit card by inputting a patient’s personal information into an online application form and submitting the form to CareCredit on the internet. The CareCredit online application form includes blanks for an applicant’s personal information, including the applicant’s name, household income, and home ownership status.
5. When Respondent and/or his staff members enrolled patients in CareCredit credit card accounts, he and/or staff did not ask patients to sign a hard copy of a CareCredit application. Instead, Respondent and/or staff members directly entered patients’ personal information into an online application form for CareCredit.
6. Respondent and/or his staff routinely entered incorrect information regarding patients’ income and home ownership status into an online credit application for a healthcare credit card. Respondent and/or his staff routinely entered annual income at or above $120,000 and that the applicant owned his/her home. Respondent and/or his staff made no attempt to obtain the actual information from the applicants.
7. Respondent failed to obtain and maintain paper credit applications completed and signed by the patients for whom he submitted the on-line credit applications, as required by his provider agreement with CareCredit.
8. Seven of the patient files reviewed by the Panel had no CareCredit Sales Draft or credit voucher, or the draft/voucher was not signed by the patient.
9. Respondent often failed to obtain patients’ signatures on payment worksheets acknowledging that they received and understood the payment options.
10. On multiple occasions, Respondent billed for services that were not documented as having been performed.
11. On multiple occasions, Respondent billed for services at a higher fate than the actual services provided would warrant, i.e. billed for one-on-one therapeutic exercises when the doctor was actually monitoring several patients at the same time, and billed for full spinal xray views when a more focused view was taken.
12. On multiple occasions, Respondent failed to document payments received or credits that should have been applied to patients’ accounts.
13. Respondent failed to adequately monitor his staff in their duties regarding the on-line credit applications; entering of payments and credits into patients’ accounts; and obtaining patients’ signatures on contracts, agreements, and sales drafts.
14. On multiple occasions, Respondent billed for x-rays or repeat x-rays with no corresponding documentation/interpretation in the patient’s chart.
15. Respondent routinely ordered x-rays consisting of single views of the area of interest, which are diagnostically insufficient.
16. Respondent ordered identical x-ray views, lateral cervical spine, and AP lumbopelvic spine on a majority of patients regardless of the presenting complaints or symptoms, and on occasion failed to obtain views of the area of interest.
17. Respondent failed to properly document radiographic studies including but not limited to written orders documenting the need for the study, the area of interest, last menstrual period (LMP) for females of child-bearing age and capacity; and written reviews detailing his interpretation of the study.
18. Respondent failed to create or maintain adequate records of care as evidenced by the following:
a. Respondent failed to document current subjective complaints and objective findings on a visit to visit basis. The records were often copies of the same note containing repeated phrases and typographical errors copied and repeated over and over for extended periods of time.
b. Respondent failed to adequately monitor his staff in their duties regarding entering daily notes and proper filing of records.
c. Several patient records had no consent for treatment or had an unsigned consent for treatment.
d. Several patient records did not have treatment plans, or the treatment plan was not signed by the patient.
e. Treatment plans were the same in all of the records reviewed by the Panel regardless of presenting complaints or findings.
19. In his written response to the Notice of Conference with Complaint Panel and at the conference with the Panel Respondent provided the following information:
a. Respondent stated that his staff were responsible for enrolling patients in CareCredit credit card accounts and staff did not enter correct annual income or home ownership information. Respondent admitted that he and/or staff made little or not attempt to discover patients’ incomes and would just “plug in a number,” assuming that the information was irrelevant to the patients’ qualification for an account.
b. Respondent admitted he had numerous recordkeeping errors, many of which he attributed to transitioning from one electronic recordkeeping/billing program to another. Respondent also indicated he allowed staff to do filing, billing, bookkeeping, and the CareCredit applications, with very little oversight from Respondent. Respondent stated he understood the Panel’s concerns and his personal responsibility, and asserted he now actively oversees staff and provides additional training for staff.
c. Respondent stated when he became aware of the errors he affirmatively made numerous changes to his practice. Respondent stated he audited all the patient files identified as having billing errors and credited patient accounts as appropriate.
d. Respondent stated all patients who requested refunds for services for which the patient paid, but did not receive, have been issued refunds to the patient’s satisfaction.
e. When utilizing pre-pay plans, if a patient terminates the plan early and requests a refund, Respondent now provides refunds without retroactively charging the patient retail cost for visits used.
f. Respondent stated he now bills pre-pay plans by billing a credit card on file as visits are used or by billing the patient month-to-month.
The Panel concludes that the conduct described in section III. above constitutes a violation of Minnesota Statutes section 148.10 for purposes of this Stipulation and Order only and justifies the action described in section V. below. Respondent agrees that the conduct described in section III. above constitutes a violation of Minnesota Statutes section 148.10 if proven by the Panel but agrees to enter into this Stipulation and Order for purposes of settlement.
A. NOW, THEREFORE, IT IS FURTHER STIPULATED AND AGREED that upon this Stipulation, and without further notice or additional proceedings, the Board may, in its discretion, adopt and implement the following Order:
B. The Board hereby SUSPENDS Respondent’s license to practice chiropractic for 18 months from the date of this order. The suspension is STAYED in its entirety contingent upon Respondent’s compliance with the terms and conditions in paragraphs B.l through B.7 and C, as follows:
1. Respondent shall enroll in and successfully complete the National Board of Chiropractic Examiners (NBCE) Post Licensure Examination in Ethics and Boundaries at its first offering following the effective date of this order. The program information may be found online at http://www.nbce.org/index.html. Failure to obtain a passing score will be considered a violation of this order.
2. Respondent shall complete not less than ten (10) hours of continuing education in healthcare documentation and proper coding procedures within 60 days of the effective date of this Order. These hours shall be provided by an instructor pre-approved by the Board. If the approved instructor is also a Board approved continuing education sponsor, only then shall these hours apply toward the annual license renewal requirements.
4. Respondent shall develop a detailed “Policies and Procedures” manual covering records management, billing procedures, and patient-account maintenance. This manual shall be completed and submitted to the Panel for review and approval within 60-days of the effective date of this Order.
5. Respondent acknowledges and agrees that all radiographic studies require and will be accompanied by a written radiographic interpretation report to be maintained in the patient’s file.
6. Respondent shall provide a copy of this Stipulation and Order to all employers, employees, staff, and associates within 30 days of the date it is approved by the Board and within 30 days of any new hire or new association. Respondent shall secure and maintain an individual notarized affidavit from each employer, employee, staff, and associate verifying they have received and read this Stipulation and Order. Respondent shall provide copies of these notarized affidavits upon request by the Board.
7. Respondent shall arrange for participation in and completion of the above requirements and shall assume responsibility for all associated costs.
C. The Board imposes a CIVIL PENALTY in the amount of $30,000. The civil penalty shall be paid by cashier’s check or money order made payable to the Minnesota Board of Chiropractic Examiners and shall be delivered personally or by mail to the Minnesota Board of Chiropractic Examiners, c/o Dr. Larry Spicer, Executive Director, 2829 University Avenue S.E., Suite 300, Minneapolis, Minnesota 55414, within 60 days of the date of service of this Order. In the alternative, Respondent may submit payment of the civil penalty in equal monthly installments over 12 months at 7% interest, ending one from the date of this Order. If a monthly payment option is selected, an amortized payment schedule will be provided. The civil penalty shall be paid by cashier’s check(s) or money order(s) made payable to the Minnesota Board of Chiropractic Examiners as specified above.
D. Respondent may petition for removal of the suspended status following eighteen (18) months from the date of this Order. The burden of proof shall be upon Respondent to demonstrate by a preponderance of the evidence that he has satisfied all the conditions of this Order and is capable of practicing chiropractic in a fit and competent manner. At the time of Respondent’s petition, Respondent may be required to meet with a Complaint Panel to review and evaluate his compliance and current practice procedures.
E. The Board may, at any regularly scheduled meeting following Respondent’s petition for removal of the stayed suspension take any of the following actions:
1. Issue an Order granting Respondent an unrestricted chiropractic license;
2. Issue an Order granting Respondent a chiropractic license with limitations upon the scope of Respondent’s practice and/or with conditions for Respondent’s practice; or
3. Continue the stayed suspension of Respondent’s chiropractic license upon his failure to meet the burden of proof.
CONSEQUENCES FOR NONCOMPLIANCE OR ADDITIONAL VIOLATIONS
A. It is Respondent’s responsibility to ensure all payments, reports, evaluations, and documentation required to be filed with the Board pursuant to this Stipulation and Order are timely filed by those making the payment or preparing the report, evaluation, or documentation. Failure to make payments or file reports on or before their due date is a violation of this Stipulation and Order. The information contained in the reports, evaluations, and documentation is confidential and shall be submitted to the Board by United States mail, courier, or personal delivery only.
Noncompliance With Requirements for Stayed Suspension
B. If the Panel has probable cause to believe Respondent has failed to comply with or has violated any of the requirements for staying the suspension as outlined in paragraphs B and C above, the Panel may remove the stayed suspension pursuant to the procedures outlined below, with the following additions and exceptions:
1. The removal of the stayed suspension shall take effect upon service of an Order of Removal of Stayed Suspension (“Order of Removal”). Respondent agrees that the Panel is authorized to issue an Order of Removal, which shall remain in effect and shall have the full force and effect of an order of the Board until the Board makes a final determination pursuant to the procedures outlined in paragraph VLC below. The Order of Removal shall confirm the Panel has probable cause to believe Respondent has failed to comply with or has violated one or more of the requirements for staying the suspension of Respondent’s license. Respondent further agrees an Order of Removal issued pursuant to this paragraph shall be deemed a public document under the Minnesota Government Data Practices Act. Respondent waives any right to a conference or hearing before removal of the stayed suspension.
2. The Panel shall schedule the hearing pursuant to paragraph VI.C below to be held within 60 days of the notice.
C. If Respondent fails to comply with or violates this Stipulation and Order or it is determined Respondent has further violated Minnesota Statutes sections 148.01 to 148.108 or Minnesota Rules chapters 2500.0100 to 2500.6050, the Panel may, in its discretion, seek additional discipline either by initiating a contested case proceeding pursuant to Minnesota Statutes chapter 14 or by bringing the matter directly to the Board pursuant to the following procedure:
1. The Panel shall schedule a hearing before the Board. At least 30 days before the hearing, the Panel shall mail Respondent a notice of the violation(s) alleged by the Panel. In addition, the notice shall designate the time and place of the hearing. Within ten days after the notice is mailed, Respondent shall submit a written response to the allegations. If Respondent does not submit a timely response to the Board, the allegations may be deemed admitted.
2. The Panel, in its discretion, may schedule a conference with Respondent prior to the hearing before the Board to discuss the allegations and to attempt to resolve the allegations through agreement.
3. Prior to the hearing before the Board, the Panel and Respondent may submit affidavits and written argument in support of their positions. At the hearing, the Panel and Respondent may present oral argument. Argument shall not refer to matters outside the record. The evidentiary record shall be limited to the affidavits submitted prior to the hearing and this Stipulation and Order. The Panel shall have the burden of proving by a preponderance of the evidence that a violation has occurred. If Respondent has failed to submit a timely response to the allegations, Respondent may not contest the allegations, but may present argument concerning the appropriateness of additional discipline. Respondent waives a hearing before an administrative law judge, discovery, cross-examination of adverse witnesses, and other procedures governing hearings pursuant to Minnesota Statutes chapter 14.
4. Respondent’s correction of a violation before the conference, hearing, or meeting of the Board may be taken into account by the Board but shall not limit the Board’s authority to impose discipline for the violation. A decision by the Panel not to seek discipline when it first learns of a violation shall not waive the Panel’s right to later seek discipline for that violation, either alone or in combination with other violations, at any time while Respondent’s license is in a Stayed Suspension status.
5. Following the hearing, the Board will deliberate confidentially. If the allegations are not proved, the Board shall dismiss the allegations. If a violation is proved, the Board may impose additional discipline, including lifting of the stay on the suspension, additional conditions or limitations on Respondent’s practice, an additional period of suspension, additional conditions of reinstatement, or revocation of Respondent’s license.
6. Nothing herein shall limit the Review Panel’s or the Board’s right to temporarily suspend Respondent’s license pursuant to Minnesota Statutes section 148.10, subdivision 4, based on a violation of this Stipulation and Order or based on conduct of Respondent not specifically referred to herein.
A. In the event Respondent should leave Minnesota to reside or to practice outside of the state, Respondent shall give the Board written notification of the new location, as well as dates of departure and return. Periods of residency and practice outside of Minnesota will not apply to the reduction of any period of Respondent’s I8-month stayed suspension in Minnesota unless Respondent demonstrates that the practice in another state conforms completely with this Stipulation and Order. If Respondent leaves the state, the terms of this Order continue to apply unless waived in writing.
B. Respondent waives the contested case hearing and all other procedures before the Board to which Respondent may be entitled under the Minnesota and United States constitutions, statutes, or rules.
C. Respondent waives any claims against the Board, the Minnesota Attorney General, the State of Minnesota, and their agents, employees, and representatives related to the investigation of the conduct herein, or the negotiation or execution of this Stipulation and Order, which may otherwise be available to Respondent.
D. This Stipulation and Order, the files, records, and proceedings associated with this matter shall constitute the entire record and may be reviewed by the Board in its consideration of this matter.
E. Either party may seek enforcement of this Stipulation and Order in any appropriate civil court.
F. Respondent has read, understands, and agrees to this Stipulation and Order and has voluntarily signed the Stipulation and Order. Respondent is aware this Stipulation and Order must be approved by the Board before it goes into effect. The Board may either approve the Stipulation and Order as proposed, approve it subject to specified change, or reject it. If the changes are acceptable to Respondent, the Stipulation and Order will take effect and the order as modified will be issued. If the changes are unacceptable to Respondent or the Board rejects the Stipulation and Order, it will be of no effect except as specified in the following paragraph.
G. Respondent agrees that if the Board rejects this Stipulation and Order or a lesser remedy than indicated in this settlement, and this case comes again before the Board, Respondent will assert no claim that the Board was prejudiced by its review and discussion of this Stipulation and Order or of any records relating to it.
H. This Stipulation and Order shall not limit the Board’s authority to proceed against Respondent by initiating a contested case hearing or by other appropriate means on the basis of any act, conduct, or admission of Respondent which constitutes grounds for disciplinary action and which is not directly related to the specific facts and circumstances set forth in this document.
DATA PRACTICES NOTICES
A. This Stipulation and Order constitutes disciplinary action by the Board and is classified as public data pursuant to Minnesota Statutes section 13.41, subdivision 5. Data regarding this action will be provided to data banks as required by Federal law or consistent with Board policy. While this Stipulation and Order is in effect, information obtained by the Board pursuant to this Order is considered active investigative data on a licensed health professional, and as such, is classified as confidential data pursuant to Minnesota Statutes section 13.41, subdivision 4.
B. This Stipulation contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies this Stipulation.
BOARD OF CHIROPRACTIC EXAMINERS
Jeffrey M. Styba, D.C.
Dated March 29, 2011
Larry A. Spicer, DC
Dated April 14, 2011
Upon consideration of the Stipulation, the Board places Respondent’s license in a SUSPENOED status, said suspension shall be STAYED, issues Respondent a CIVIL PENALTY, and adopts all of the terms and conditions described above on this 14th day of April, 2011.
OF CHIROPRACTIC EXAMINERS
Richard R. Tollefson,
This article was posted on February 8, 2016.