Mid-Year (2002) Review of the ACA Lawsuits

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Thanks to the:   American Chiropractic Association for the use of this article!

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Since January of this year, several events have moved the ACA's lawsuits against the Department of Health and Human Services and Trigon Blue Cross Blue Shield of Virginia forward in positive directions for chiropractic. Following is a synopsis of significant developments:

Update on Lawsuit Against HHS

The Department of Health and Human Services in January issued a policy directive to Medicare Carriers that states that Medicare managed care organizations will no longer be able to use physical therapists to provide the chiropractic benefit of "manipulation of the spine to correct a subluxation," reversing a policy that has existed since 1994.

While the policy directive marked a significant victory, ACA still has further to go in its litigation against HHS, which maintains its position that doctors of osteopathy and medicine can continue to be reimbursed for providing the specific chiropractic benefit.

All sides have filed their motions for summary judgments and are awaiting the judge's decision.

Update on Lawsuit Against Trigon Blue Cross Blue Shield

ACA attorney George McAndrews in February filed a motion to compel with the federal court in Abingdon, VA, to force Trigon Blue Cross Blue Shield of Virginia to answer questions regarding the basis of its discriminatory practices. More specifically, McAndrews filed a set of "interrogatories" with Trigon centering on the contention that Trigon BC/BS often "pays limited licensed providers (chiropractors) less than we pay medical doctors for the same procedure..."

In its follow-up to that admission, ACA set forth studies and sworn testimony by medical authorities that contradict Trigon's implication that medical doctors have a higher degree of knowledge and skill than do doctors of chiropractic with respect to musculoskeletal conditions. ACA also asked Trigon to specify how these studies and testimony relate, if at all, to its discriminatory reimbursement policies and to indicate which of the studies and sworn testimony it views as uncredible and why.

The judge considered the motion to compel and ruled in ACA's favor, requiring that Trigon respond to the questions and provide the specific rationale used to determine its policy of paying doctors of chiropractic less than medical doctors for the same service.

ACA was forced to file another motion to compel after Trigon refused to provide other specific information on how it established its overall reimbursement policy for other providers-information ACA wants in order to compare it with the treatment afforded to chiropractors. At press time, the judge has yet to rule on the motion.

Meanwhile, depositions with officials from Trigon Blue Cross Blue Shield of Virginia, as well as the Medical Society of Virginia, have commenced in recent months. The first deposition took place April 23 in Richmond, VA, with former Trigon medical director Dr. Larry Colley. The deposition was the first opportunity for ACA attorney George McAndrews to probe a Trigon official regarding statements made in June 2000 by Trigon officials during a meeting with ACA and VCA representatives to discuss discriminatory practices toward the chiropractic profession. It was at that meeting, which Dr. Colley attended, that Trigon officials made the following statements, summarizing their attitudes toward chiropractors:

1.   They pay chiropractors less because chiropractors were willing to accept less;

2.   They pay chiropractors less for the same service because they consider DCs limited practitioners--notwithstanding superior training and skills in musculoskeletal conditions;

3.   They had no intention of changing their policies or trying to accommodate ACA concerns.


Dr. Colley's deposition lasted from 9:15 a.m. to 5:00 p.m., with an hour break for lunch. At the request of Trigon attorneys, McAndrews agreed that the deposition would be kept under a confidentiality seal for approximately 30 days, after which time Trigon must argue why all or parts of the deposition should remain sealed.

A few days following Dr. Colley's deposition, ACA received word that Trigon had been bought-out by Anthem, a company that currently controls Blue Cross Blue Shield plans in eight states. The deal makes Anthem the second largest Blue Cross plan in the country. It would means that Anthem assumes all of Trigon's assets and liabilities, including the ACA lawsuit.

In other news, the Medical Society of Virginia is resisting ACA's discovery efforts. Its former president (later president of the American Medical Association) was a member of the AMA's infamous and illegal "Committee on Quackery," whose only function was to destroy the chiropractic profession.

Through the depositions, ACA has an opportunity to confirm what it has believed for years: that the conspiracy between organized medicine and the insurance industry continues. ACA's central focus is to underscore and attack the rationale used to discriminate against chiropractors in terms of reimbursement and coverage.

No other issue since the Wilk case has brought together so many different organizations within the chiropractic profession. In addition to ACA, support for the lawsuit against Trigon has come from the International Chiropractors Association, the World Chiropractic Alliance, the Congress of Chiropractic State Associations, the Federation of Chiropractic Licensing Boards, the National Association of Chiropractic Attorneys, the Association of Chiropractic Colleges, and numerous state and local associations.

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