Quebec Naturopathic Physician Continuing Education

• Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct..
• Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies.
• Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees.
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements.
• Explain the development of current fee discounting legislation, rules and holdings.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks.
• Assess one’s working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider’s practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally.
• Verify how certain discount practices may be legally actionable as “improper inducements.”
• Evaluate federal Stark legislation and the discouragement of corruption in sound professional healthcare decision-making.
• Identify distinctions between federal anti-kickback and the federal Stark legislation.
• Critique state anti-kickback laws.
• Recognize the role the FTC played, and continues to play, in discouraging the fraudulent marketing of discount health care programs.
• Draw associations between co-pay requirements, consumer habits and federal healthcare expenditures.
• Assess how "professional courtesy" discounts may raise enforcers' concerns under the federal anti-kickback statute.
• Diagram how prepaid fee arrangements often resemble health insurance to unwitting patients.
• Illustrate pitfalls that advertising discounts visit on the practitioner.

• Assess state, federal and board rulings regarding fee discounts, particularly time-of-service discounts and hardship discounts, and the extent to which they may be impacted by anti-kickback legislation, insurance regulations, self-referral laws, marketing restrictions, and the tenets of unprofessional conduct..
• Identify potential problems associated with routine approval of hardship discounts and the requirement for inquiry and documentation regarding qualifying for same.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate how these discounts are regarded by relevant professional boards, and state and federal enforcement agencies.
• Explain terms associated with time of service discounts and relevant factors associated in calculating an appropriate reduction in fees.
• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to pre-paid fee arrangements.
• Explain the development of current fee discounting legislation, rules and holdings.
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services.
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks.
• Assess one's working knowledge regarding the process by which state and federal rulings regarding fees impact a healthcare provider's practice in light of marketing, fee-splitting and anti-kickback legislation, insurance regulations, self-referrals, and the tenets of unprofessional conduct generally.

• Assess how state scopes of practice affect chiropractic treatment of nutrition-related health problems.
• Identify the roles the FDA and FTC play in the administration of nutritional healthcare.
• Distinguish between a "food" and a "drug" for purposes of nutritional supplementation.
• Demonstrate how the various states' ban against the practice of medicine affects other disciplines' approach to nutritional healthcare.
• Explain aspects of nutrition labeling.
• Identify issues associated with current performance-enhancing supplementation.
• Explain the significance of distinguishing "treatment" from "informing" as it relates to nutritional counseling.

• Assess the relationship between the implementation of efficient office systems, accurate record keeping, patient communication, and adherence to professional standards of conduct within the context of malpractice allegations by patients who engage in sports.
• Identify actions suggestive of malpractice negligence and conduct that fails to live up to the standard established by law for the protection of others.
• Demonstrate a professional relationship can spring into existence when the healthcare professional is hired by a third party to oversee the health of athletic participants.
• Distinguish the duties an examining physician has regarding informing those athletes he examines about abnormal test results.
• Explain the legal concept of “assumption of the risks” within the context of sports participation and how it affects a healthcare professional’s liability.
• Identify “therapeutic exceptions” to providing informed consent excusing the practitioner from fully disclosing matters where they might unfavorably affect the outcome of a patient’s treatment.
• Explain a healthcare professional’s duty to warn patients engaged in sports regarding injury prevention following treatment.
• Examine a practitioner’s duties regarding athletes’ return to play in instances when head injury and concussion may be a factor.

• Assess the role the doctor-patient relationship plays in allegations of Patient Abandonment
• Identify the components to any successful Patient Abandonment charge
• Discuss court cases evaluating whether the doctor-patient relationship had been terminated lawfully
• Distinguish between proper and improper considerations a doctor may rely upon to either refuse to undertake, or to terminate, a doctor-patient relationship
• Explain the role notice plays in lawfully terminating a doctor-patient relationship
• Evaluate the role consent plays in the establishment of the doctor-patient relationship, and in subsequent treatment

• Identify specific conduct and activities within the practice of healthcare that violate a host of regulatory and statutory proscriptions relating to fee splits and kickbacks
• Explain the development of current fee-splitting laws
• Distinguish the letter of the law regarding fee-splitting and anti-kickback legislation from unprofessional conduct and consequent harms the statutes were enacted to discourage
• Demonstrate a working knowledge regarding the roles played by the various state and federal enforcement agencies as they related to fee splits and kickbacks
• Assess ones working knowledge regarding the process by which anti-referral safe harbors developed and how they operate

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the practice of forensic science
• Identify a new dimension of chiropractic practice that will minimize risks and failure in court appearances as a practitioner
• Construct skill sets in forensic examination and document review

• Acquire a current knowledge base relating to medicolegal issues
• Identify risks and liabilities that may be encountered by examiners with electronic communications
• Develop a level of understanding of the medicolegal system as it relates to Junk Science

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the ethical expert witness
• Introduce a new dimension of chiropractic practice that will minimize risks and failure in court appearances as an ethical expert witness.
• Encourage development and nurturing of skill sets in forensic examination and appearing as an expert witness through certification.
• Develop a level of understanding of the medicolegal system as it relates to the ethical expert witness.

• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Identify Daubert criteria
• Discuss what each chiropractic expert should look for when preparing for the opposing attorney
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to Daubert challenges
• Encourage development and nurturing of skill sets in proving expert opinions

• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Identify the basics of a deposition
• Discusses the tricky question types and suggested responses
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to the deposition process
• Encourage development and nurturing of skill sets in responding to questions posed in a deposition

• Perform professional advertising and marketing that passes state and federal legal restriction.
• Comprehend requirements for advertising testimonials, press releases, television, radio, Internet, personal solicitation and other marketing initiatives.
• Comprehend the limits of commercial speech (advertising) within the arena of professional healthcare marketing and dissemination of information.
• Train staff and implement policies associated with marketing initiatives and materials vis-a-vis state rules, regulations and statutes.
• Comprehend issues associated with signage, listings, letterhead, and other matters of ostensible agency that may lead to liability.
• Administer professional marketing such that it neither misleads, confuses nor exploits members of the public.
• Discuss how nutritional supplementation labeling and HIPAA affects professional healthcare marketing efforts.
• Undertake a review of marketing materials and initiatives so as to ensure compliance with relevant state rules, regulations and statutes.
• Administer coverage decisions, professional referrals, and communicate same in a manner that limits professional liability.

• Identify common risky mistakes providers make when navigating patient financial matters
• Recognize the providers financial obligation when treating Medicare & Medicare Advantage patients
• Review both federal and payer guidelines on managing patient financial obligations
• Identify practical ways to manage non-covered services and uninsured patients

• Analyze charges and documentation on a daily or per visit basis to ensure accuracy and compliance
• Compile accurate and comprehensive responses to documentation or record requests
• Recognize and avoid confusing HIPAA privacy issues that can cost you time and money
• Identify key areas that lack written policies causing increased risk in the practice
• Evaluate your current written procedures and appraise the need for additional content

Hour 1

• Identify various types of billing irregularities and impact on healthcare expenditures.
• Distinguish upcoding from bundling within the context of irregular billing schemes.
• Demonstrate how and when exceeding a state’s scope of practice becomes “the unauthorized practice of medicine.”
• Explain the restrictions states’ scopes of practice place on healthcare providers’ authority to treat and diagnose patients.
• Discuss how invoicing unrendered medical services impacts third-party payers.
• Interpret chiropractic boards’ positions on testimonial advertising and how best to comply.

Hour 2

• Identify what constitute a false claim under the False Claims Act.
• Discriminate a kickback from a self-referral.
• Trace how anti-kickback legislation arose and examine its prohibitions.
• Explain the enactment of Stark legislation arising on the heels of anti-kickback bans.
• Assess providing nutritional counsel within the context of “the practice of medicine.”
• Evaluate identity theft and its impact on patients, providers and the cost of healthcare.
• Discriminate between illegal copayment waivers from proper hardship waivers.
• Discuss court cases instancing successful prosecution of healthcare fraud.

• Identify the 18 PHI Identifiers
• Awareness of other HIPAA related documentation and the appropriate retention period
• How to confirm retention period for healthcare records
• Recognize required security measures and their value to practice risk management
• Implement policy and protocol for compliant and secure disposal of records

• Be able to identify the definitions of Fraud, Waste and Abuse and how they may show up in day-to-day practice
• Become aware of the source of overpayments, including not-medically necessary care, maintenance care, and active treatment
• Apply the guidance from the OIG to your state and carrier regulations since they are a resource to these groups
• Recognize insufficient documentation and incorrect coding before the billing takes place
• Implement the action steps recommended by the OIG to eliminate incorrect documentation, billing and coding practices to reduce compliance risk

• Distinguish between fraud, waste and abuse
• Review and properly utilize your Medicare Local Coverage Articles (LCA)
• Integrate critical compliance requirements for minimum, mandatory, annual self-audits  
• Detect common billing protocols that are red-flags for third-party auditors and chiropractic boards of examiners

• Identify the expected standards of a compliant and complete patient medical record
• Audit documentation to ensure the most important details are present
• Analyze and correct for the four most commonly missed components of appropriate documentation
• Apply the federal requirements for Medicare documentation and use this knowledge to initial and routine patient visit documentation

• Assess limits of state, federal and board authority regarding the prohibition of solicitation of patients by, and on behalf of, chiropractors. 
• Explain distinctions between general marketing and intrusive solicitation, and the reasons for the regulation of each
• Demonstrate how the courts protect businesses’ right to advertise and how they discourage deceptive practices. 
• Distinguish between appropriate and inappropriate/illegal marketing relating to fees and professional services. 
• Examine criminal and civil laws associated with overly aggressive chiropractic advertising.

• Classify circumstances that trigger Good Samaritan laws for chiropractors.
• Restate duties imposed upon people in the United States to render aid to others in dire circumstances.
• Compare a doctor’s versus a lay person’s duty to render aid to someone in distress.
• Explain principles and philosophical underpinning Good Samaritan laws.
• Discuss the Bystander Effect.and scientific studies that unearth reasons why people are reluctant to render aid/assistance to others in emergency situations.
• Summarize the role compensation, expecting to get paid, plays in the operation of Good Samaritan laws.
• Locate states that impose a duty to render assistance, and those states that remove Good Samaritan law protection from hospitals.
• Identify protections offered under various states’ Good Samaritan Laws.
• Express the relaxation of professional standards, and what behaviors are shielded from liability, under Good Samaritan laws.

• Recognize and execute the rules to avoid inducement violations
• Define what you CAN give away for a first visit that will not break the rules. 
• Implement compliant initial visit screening services as part of a new patient offer
• Apply risk management rules to avoid offering free services to some and not others
• Modify your current marketing strategy to attract new patients while being compliant

• Identify ethical and legal prohibitions against patient deception, misinformation, exaggerating healthcare cures, guaranteeing treatment results, and dishonesty.
• Distinguish between appropriate and inappropriate communications and medical file entries describing patients' healthcare prognoses and progress.
• Explain scientific literature linking patients' attitude and mental states to healthcare outcomes.
• Illustrate placebo-enhancing doctor-patient interactions that comply with states' prohibitions against deception and misinformation.
• Give examples where ethical patient encouragement authentically fosters positive mental states that promote desired patient outcomes.
• Express why patient communications must be consistent with medical file entries regarding prognoses and patient progress.
• Explain office procedures and staff training likely to optimize health-promoting ethical patient communication and the documentation thereof.

• Identify which portion of the complex regulation applies to their practice
• Recognize proper use of a Good Faith Estimate vs Balance Billing Protection form
• Formulate customized forms and training tools to meet regulatory guidelines
• Adopt best practices and regulation standards during the patient intake process

• Discuss the public’s increased use of health data-gathering devices and its effect on dispensing healthcare by professional healthcare providers.
• Identify sources for state authority to regulate the practice of healthcare in the various states.
• Explain states’ prohibition against the unauthorized practice of medicine and identify points where data collection and subsequent evaluation may encounter this prohibition.
• Compare courts’ interpretations of state scopes of practice laws as they relate to the various stages of a doctor-patient encounter.
• Distinguish data collection from activities that may include preliminary evaluation, diagnosis, and treatment - while identifying their relevance to state scopes of practice.
• Analyze how courts interpret activities that may constitute the unauthorized practice of medicine, as distinguished from those that do not.
• Discuss obligations to refer people to other healthcare providers based upon determinations and/or diagnoses related to observation, examination, and evaluation of collected data.
• Distinguish boundaries regarding data collection versus the unauthorized practice of medicine.
• Recognize the public's rights to information and free speech protections.

 Part 1

• Discuss the costs of fraud and financial crime
• Review the technology trajectory and how this affects fraud
• Quote Honesty studies
• Identify behaviors related to cheating

Part 2

• Review the criminological and behavioral theories of fraud in healthcare
• Explain key aspects of the psychological of fraud
• Identify aspects of sociology related to fraud
• Examine: Biological school of criminology

Part 3

•  Examine victimology and victim behavior
• Discuss internal fraud and trends
• Examine opportunity reduction
• Be aware of red flag and fraud indicators

 Part 4

• Apply human based preventative and detection strategies to avoid fraud
• Use technology based preventative and detection strategies to avoid fraud
• Use vulnerability assessment preventative and detection strategies

• Compare the various Responsibilities that patients owe to the doctor-patient relationship
• Describe the doctor-patient relationship as a dynamic one that relies on the active participation of patient and doctor alike, and enlists aspects of trust in order for the interaction to render optimal benefits.
• Recognize how the Hippocratic Oath contributed significantly to the development of chiropractic patient rights
• Discuss the historical evolution of Patients' Rights in the United States and their application to chiropractic
• Explain the various Patients’ Rights
• Present case studies to illustrate how patient rights and responsibilities can be applied in practice.
• Analyze how Patient Obligations contribute to the success of the doctor-patient interaction and can favorably impact patient outcomes.
• Explain how chiropractors’ efforts to enhance profitability could negatively impact both public perception and the bottom line.

• Appreciate the significance of Artificial Intelligence (AI) in transforming the healthcare industry.
• Recognize the potential benefits of AI in improving diagnosis accuracy and treatment outcomes.
• Identify how AI can streamline administrative processes, such as scheduling appointments, billing, forms, and managing patient records.
• Explore compliance with laws and regulations when using AI and chatbots in advertising, including rules around data collection and use
• Understand the challenges of determining who owns the copyright for content generated by AI systems
• Evaluate the importance of keeping up-to-date with technological advancements in healthcare for quality patient care and practice management
• Comprehend the challenges regarding patient data privacy and security associated with AI.

• Recognize different forms of social media and how clinics can benefit from using social media
• Appreciate the risks of using social media and how to avoid any pitfalls
• Develop policy and procedures to protect patient information when using social media
• Ability to identify commonly overlooked risks when communicating to patients on third-party software platforms

• Distinguish Constitutionally-protected expression contributing to a healthy marketplace, from defamatory reviews that damage doctors and impede intelligent consumer activity.
• Explain what triggers patient complaints and discuss how their constructive information improves healthcare services.
• Identify how patient complaints can compromise doctors’ health, devastate their businesses, impede professional performance, and compromise patient outcomes.
• Express how doctors may shape doctor-patient relationships so as to reduce the likelihood and frequency of patient complaints.
• Illustrate how a doctor's proactive remedial behavior can mitigate the incidence and severity of formal disciplinary actions and litigation generally.
• Explain the power traditionally ascribed to word-of-mouth recommendations and how current social media review systems leverage this power.
• Discuss how the Consumer Review Fairness Act restricts prohibitions against posting negative reviews.
• Describe how a complaint navigates a state Board disciplinary process and factors regarding appeal.
• Illustrate the financial and reputational costs that attend doctors responding to negative complaints and/or initiating litigation against patients.