Preview
FILED
DALLAS COUNTY
12/9/2019 6:40 PM
FELICIA PITRE
DISTRICT CLERK
THIS DOCUMENT
NOTICE: THIS DOCUMENT CONTAINS
CONTAINS SENSITIVE DATA Terri Kilgore
CAUSE NO.
N0. DC-19-13584
DC—l9-13584
IN THE DISTRICT COURT
ALFONSO LARA,
PLAINTIFF,
160TH JUDICIAL DISTRICT
160T“ JUDICIAL DISTRICT
VS.
DAYAKAR PINDI
DEFENDANT(S). DALLAS COUNTY, TEXAS
COUNTERAFFIDAVIT, PURSUANT 18.001 OF THE TEXAS
PURSUANT TO SECTION 18.001 TEXAS CIVIL
PRACTICE AND REMEDIES
PRACTICE AND CODE CONCERNING
REMEDIES CODE THEREASONABLENESS
CONCERNING THE AND
REASONABLENESS AND
AND COSTS PROVIDED TO
NECESSITY OF SERVICES AND
ALFONSO LARA
BEFORE
BEFORE ME, ME, the
the undersigned
undersigned authority, on this
authority, on this day
day personally
personally appeared
appeared Ryan
Ryan
Robinson,
Robinson, D.C.,
D.C., CCSP,
CCSP, who,
who, after
after being
being duly
duly sworn,
sworn, deposed as follows:
deposed as follows:
"My
“My name is is Ryan
Ryan Robinson, D.C., CCSP.
Robinson, D.C., CCSP. II am
am over
over the
the age
age of
of 21,
21, of
of sound
sound mind,
mind, and
and
capable of making
capable of making this
this affidavit.
affidavit. The
The facts
facts stated
stated in
in this
this affidavit
affidavit are
are within my
within my personal
personal
knowledge and
knowledge and are
are true
true and
and correct.
correct. II am
am aa Doctor
Doctor of
ofChiropractic,
ChirOpractic, licensed
licensed to to practice
practice in
in the
the
State
State of
of Texas.
Texas. Please
Please see
see my curriculum
curriculum vitae
vitae attached
attached hereto,
hereto, and
and incorporated
incorporated herein,
herein, by
by
'
reference, as
reference, as Exhibit
Exhibit A.
A.
II am
am aaperson
personqualified
qualified bybyknowledge,
knowledge, skill,
skill, experience,
experience, training,
training, and
and education,
education, to
t0
provide an
provide an opinion
opinion in
in contravention
contravention toto the
the affidavits
affidavits regarding the cost
regarding the cost and necessity
necessity of the
the
medical
medical services
services provided
provided to
to Alfonso Lara the
Alfonso Lara the years.
years. II received
received my Doctor
Doctor of Chiropractic
Chiropractic degree
degree
from
from Parker
Parker University,
University, Dallas,
Dallas, TX in
in 2013
2013 and
and I've
I’ve worked
worked in
in the
the field
field of
of chiropractic
chiropractic medicine
as
as Chief
Chief Chiropractic
Chiropractic Officer
Officer for
for several
several offices.
offices.
During
During my timetime as
as aa licensed
licensed and
and practicing
practicing Chiropractor
Chiropractor since
since 2013,
2013, II have
have become
become
familiar with billing
familiar with billing practices and medical
practices and medical services
services ofof chiropractors in the
chiropractors in the State
State of Texas.
Texas. My
knowledge, skill,
knowledge, skill, experience,
experience, education,
education, and
and training
training allow
allow me
me to
to determine
determine what
what medical
medical
services
services are
are medically
medically necessary,
necessary, medically
medically related,
related, and/or
and/or medically
medically justified.
justified. Moreover,
Moreover, my
knowledge, skill,
knowledge, skill, experience,
experience, education,
education, and
and training
training allow
allow me to
to determine
determine the
the cost
cost of
of medical
medical
services
services provided
provided that
that are
are reasonable
reasonable andand whether
whether the
the medical
medical services
services provided
provided were necessary.
necessary.
LARA VS.
LARA VS. PINDI
PAGE 1I OF
0F66
II have
have personally
personally reviewed the medical
reviewed the medical records
records and
and billing
billing records,
records, regarding
regarding Alfonso
Alfonso
Lara. I did not examine
Lara. I did not examine Mr.Mr. Lara.
Lara. I Iam
am familiar
familiar with
with the
the type
type of
ofinjury
injury allegedly
allegedly incurred
incurred by
by
Mr. Lara
Mr. Lara through
through my review
review of
of the
the medical
medical records
records from
from the
the medical
medical service
service providers listed
providers listed
herein.
herein.
I reviewed
I reviewed the
the following
following records:
records:
1.
l. Radiology Consultants
Radiology Consultants ofNorth
of North Texas;
Texas;
2.
2. Cano Health & Rehab Clinics;
Cano Health & Rehab Clinics;
3.
3. Medical Centers;
AM/PM Medical Centers;
4.
4. DFW MRI;
DFW MRI;
5.
5. Epic Pain
Epic Pain and
and Orthopedics;
Orthopedics;
6.
6. Bills and
Bills and Invoices:
Invoices: Cano
Cano Health
Health & Rehab Clinics,
Clinics, AM/PM Medical
Medical Centers,
Centers,
DFW MRI,
DFW MRI, Health
Health Insurance
Insurance Claim
Claim Form,
Form, Epic
Epic Pain
Pain and
and Orthopedics,
Orthopedics,
Radiology Consultants
Radiology Consultants ofNorth
of North Texas.
Texas.
Based on
Based on my
my knowledge,
knowledge, skill,
skill, experience, training, and
experience, training, and education,
education, II have
have formed the
formed the
following Opinion:
following opinion:
The chiropractic
The chiropractic services rendered t0
services rendered to Alfonso
Alfonso Lara,
Lara, and those costs
and those costs associated
associated with
with them,
them,
for treatment
for treatment he
he received
received in
in connection
connection with
with an
an automobile
automobile accident
accident occurred on or
which occurred about,
0r about,
December
December 4,
4, 2018,
201 8, were
were not
not entirely
entirely reasonable
reasonable and
and necessary.
necessary.
Specifically:
Specifically:
My
My name
name is is Ryan
Ryan Robinson, D.C., CCSP,
Robinson, D.C., CCSP, II amam licensed
licensed by by the
the State
State ofof Texas
Texas as as aa
Chiropractor. I have over 6 years of experience treating
Chiropractor. I have over 6 years of experience treating patients
patients as
as aa chiropractor
chiropractor in
in the
the DFW
area,
area, and
and during the past
during the past 66 plus
plus years
years II have
have also
also from
from time
time toto time
time treated
treated patients in 4
patients in 4
chiropractic clinics in Plano, Grapevine, Saginaw,
chiropractic clinics in Plano, Grapevine, Saginaw, and
and Fort
Fort Worth,
Worth, Texas.
Texas. The
The patients
patientsJ,I have
have
treated
treated include
include hundreds
hundreds of
of patients
patients with
with complaints
complaints ofof pain
pain in
in the
the spine
spine and
and extremities
extremities from
from
motor
motor vehicle accidents. II completed
vehicle accidents. completed aa post
post graduate
graduate certification
certification in in sports
sports in
in November
November of of
2015,
2015, which
which enables
enables meme to
to diagnose
diagnose and
and treat
treat traumatic
traumatic injuries
injuries more effectively.
effectively.
My
My comments
comments on on reasonable allowanceshere
reasonable allowances here are
are based
based upon
upon my my many
many years
year's of
0f
experience
experience inin treating
treating patients
patients with
with such
such conditions.
conditions. Many of of the
the patients
patients II have dealt
dealt with
with and
and
deal
deal with
with daily
daily have
have high
high deductibles
deductibles and
and it
it has
has been
been necessary
necessary forfor me to contact imaging centers
to contact imaging centers
and other
and other providers
providers to
to ascertain
ascertain what
what would
would be
be the
the most
most appropriate
appropriate referral
referral pattern
pattern for
for my
my
patients, to assure they get quality care that they
patients, to assure they get quality care that they can can afford.
afford. As a
a result,
result, I
I have
have a strong
strong idea
idea of
of
reasonable
reasonable charges
charges for
for the
the services
services on
on which
whichII comment.
In
In reference
reference to
t0 the
the use
use of
0faadetailed
detailed exam,
exam, the
the CPT
CPT Coding
Coding Manual
Manual requires
requires three
three key
key .
components:
components: detailed
detailed history,
history, detailed
detailed exam,
exam, and moderate level
and moderate level of
of medical
medical decision-making.
decision-making. In In
LARA
LARA VS.
VS. PINDI
PINDI
om
PAGE20F6
19/1052
addition, the
addition, the problem
problem severity
severity should
should be
be low,
low, and
and physician
physician time
time at
at least
least 30
30 minutes.
minutes. From
From the
the
documentationprovided,
documentation provided,itit appears
appearsthese
these criteria
criteriahave
have been
been met
met and
and the
the service
service is
is therefore
therefore
necessary.
necessary.
In reference
In reference to
to the
the x-rays
x-rays performed
performed on
on this
this claimant,
claimant, based
based on
on the
the mechanism of
mechanism of injury
injury
and the
and the claimant’s
claimant's age,
age, these
these are
are both
both reasonable and necessary.
reasonable and necessary.
In reference
In reference to
to the
the use
use of
0f electrical muscle stimulation,
electrical fnuscle stimulation, manual
manual therapy,
therapy, ultrasound,
ultrasound, based
based
on my clinical experience,
on my clinical experience, this
this modality
modality has
has clinically
clinically been
been demonstrated
demonstrated to
to provide short-term
shOIT-term
pain relief
pain relief and
and increase
increase spinal
spinal mobility
mobility to to facilitate
facilitate spinal
spinal manipulation.
manipulation. Based
Based onon the
the article
article
entitled
entitled "Philadelphia
“Philadelphia Panel
Panel evidence-based
evidence-based clinical
clinical practice
practice guidelines
guidelines on selected
selected rehabilitation
rehabilitatiou
interventions for
interventions for neck
neck pain”
pain" dated
dated October
October 2001,
2001, for
for several
several interventions
interventions andand indications (eg,
indications (cg,
thermotherapy,therapeutic
thermotherapy, therapeuticultrasound,
ultrasound,massage,
massage,electrical
electricalstimulation),
stimulation),there
therewas
wasaa lack
lack of
of
evidence regarding
evidence regarding efficacy.
efficacy. Additionally,
Additionally,inin my my professional
professional opinion,
opinion, if used,
if used, would not be
would not be
recommended past
recommended past 2-3
2-3 weeks
weeks postpost initial
initial presentation
presentation to to the
the treating
treating doctor'.
doctorl. Instead,
Instead, patients
patients
should be weaned off passive therapies and transitioned
should be weaned off passive therapies and transitioned into
into active
active care,
care, as
as the
the use
use of
of active
active care
care
is associated
is with aa much
associated with much better
better clinical
clinical outcome.
outcome. Therefore,
Therefore, reimbursement
reimbursement is is only
only reasonable
and necessary for the first 3 weeks
and necessary for the first 3 weeks of of treatment.
treatment.
In reference
In to the
reference t0 the use
use of
ofmechanical
mechanical traction,
traction, based
based on
0n my
my clinical
clinical experience,
experience, this
this
modality has clinically
modality has clinically been
been demonstrated
demonstrated to
to provide
provide short-term
short-term pain
pain relief
relief and increase spinal
and increase spinal
mobility
mobility toto facilitate
facilitate spinal
spinal manipulation.
manipulation. Based Based onon the
the article
article entitled
entitled "Philadelphia
“Philadelphia Panel
Panel
evidence-based
evidence-based clinical
clinical practice
practice guidelines
guidelines on0n selected rehabilitation interventions for neck pain”
selected rehabilitation interventions for neck pain"
dated
dated October
October 2001,
2001, studies
studies have
have concluded
concluded there
there is
is limited
limited documentation
documentation of
of efficacy
efficacy of
cervical traction beyond short-term pain reduction. In
cervical traction beyond short-term pain reduction. In general, general, it
it would
would not
not be advisable
advisable to
to use
these modalities
these modalities beyond
beyond 2-32-3 weeks
weeks ififsigns
signsof of
objective
objectiveprogress
progress towards
towards functional
functional
restoration are not demonstrated'. Instead,
restoration are not demonstrated‘. Instead, patients
patients should
should be weaned off passive
passive therapies
therapies and
and
transitioned into active
transitioned into active care,
care, as
as the
the use
use of
of active
active care
care isis associated
associated with
with aa much
much better
better clinical
clinical
outcome. Therefore,
outcome. Therefore, reimbursement
reimbursement is
is only
only reasonable
reasonable and
and necessary
necessary up
up to
to the following
following up to
to
the
the first
first 33 weeks
weeks of
of treatment.
treatment.
In
In reference
reference to to the
the Chiropractic
Chiropractic Adjustment,
Adjustment, fr
Preview
FILED DALLAS COUNTY 12/9/2019 6:40 PM FELICIA PITRE DISTRICT CLERK THIS DOCUMENT NOTICE: THIS DOCUMENT CONTAINS CONTAINS SENSITIVE DATA Terri Kilgore CAUSE NO. N0. DC-19-13584 DC—l9-13584 IN THE DISTRICT COURT ALFONSO LARA, PLAINTIFF, 160TH JUDICIAL DISTRICT 160T“ JUDICIAL DISTRICT VS. DAYAKAR PINDI DEFENDANT(S). DALLAS COUNTY, TEXAS COUNTERAFFIDAVIT, PURSUANT 18.001 OF THE TEXAS PURSUANT TO SECTION 18.001 TEXAS CIVIL PRACTICE AND REMEDIES PRACTICE AND CODE CONCERNING REMEDIES CODE THEREASONABLENESS CONCERNING THE AND REASONABLENESS AND AND COSTS PROVIDED TO NECESSITY OF SERVICES AND ALFONSO LARA BEFORE BEFORE ME, ME, the the undersigned undersigned authority, on this authority, on this day day personally personally appeared appeared Ryan Ryan Robinson, Robinson, D.C., D.C., CCSP, CCSP, who, who, after after being being duly duly sworn, sworn, deposed as follows: deposed as follows: "My “My name is is Ryan Ryan Robinson, D.C., CCSP. Robinson, D.C., CCSP. II am am over over the the age age of of 21, 21, of of sound sound mind, mind, and and capable of making capable of making this this affidavit. affidavit. The The facts facts stated stated in in this this affidavit affidavit are are within my within my personal personal knowledge and knowledge and are are true true and and correct. correct. II am am aa Doctor Doctor of ofChiropractic, ChirOpractic, licensed licensed to to practice practice in in the the State State of of Texas. Texas. Please Please see see my curriculum curriculum vitae vitae attached attached hereto, hereto, and and incorporated incorporated herein, herein, by by ' reference, as reference, as Exhibit Exhibit A. A. II am am aaperson personqualified qualified bybyknowledge, knowledge, skill, skill, experience, experience, training, training, and and education, education, to t0 provide an provide an opinion opinion in in contravention contravention toto the the affidavits affidavits regarding the cost regarding the cost and necessity necessity of the the medical medical services services provided provided to to Alfonso Lara the Alfonso Lara the years. years. II received received my Doctor Doctor of Chiropractic Chiropractic degree degree from from Parker Parker University, University, Dallas, Dallas, TX in in 2013 2013 and and I've I’ve worked worked in in the the field field of of chiropractic chiropractic medicine as as Chief Chief Chiropractic Chiropractic Officer Officer for for several several offices. offices. During During my timetime as as aa licensed licensed and and practicing practicing Chiropractor Chiropractor since since 2013, 2013, II have have become become familiar with billing familiar with billing practices and medical practices and medical services services ofof chiropractors in the chiropractors in the State State of Texas. Texas. My knowledge, skill, knowledge, skill, experience, experience, education, education, and and training training allow allow me me to to determine determine what what medical medical services services are are medically medically necessary, necessary, medically medically related, related, and/or and/or medically medically justified. justified. Moreover, Moreover, my knowledge, skill, knowledge, skill, experience, experience, education, education, and and training training allow allow me to to determine determine the the cost cost of of medical medical services services provided provided that that are are reasonable reasonable andand whether whether the the medical medical services services provided provided were necessary. necessary. LARA VS. LARA VS. PINDI PAGE 1I OF 0F66 II have have personally personally reviewed the medical reviewed the medical records records and and billing billing records, records, regarding regarding Alfonso Alfonso Lara. I did not examine Lara. I did not examine Mr.Mr. Lara. Lara. I Iam am familiar familiar with with the the type type of ofinjury injury allegedly allegedly incurred incurred by by Mr. Lara Mr. Lara through through my review review of of the the medical medical records records from from the the medical medical service service providers listed providers listed herein. herein. I reviewed I reviewed the the following following records: records: 1. l. Radiology Consultants Radiology Consultants ofNorth of North Texas; Texas; 2. 2. Cano Health & Rehab Clinics; Cano Health & Rehab Clinics; 3. 3. Medical Centers; AM/PM Medical Centers; 4. 4. DFW MRI; DFW MRI; 5. 5. Epic Pain Epic Pain and and Orthopedics; Orthopedics; 6. 6. Bills and Bills and Invoices: Invoices: Cano Cano Health Health & Rehab Clinics, Clinics, AM/PM Medical Medical Centers, Centers, DFW MRI, DFW MRI, Health Health Insurance Insurance Claim Claim Form, Form, Epic Epic Pain Pain and and Orthopedics, Orthopedics, Radiology Consultants Radiology Consultants ofNorth of North Texas. Texas. Based on Based on my my knowledge, knowledge, skill, skill, experience, training, and experience, training, and education, education, II have have formed the formed the following Opinion: following opinion: The chiropractic The chiropractic services rendered t0 services rendered to Alfonso Alfonso Lara, Lara, and those costs and those costs associated associated with with them, them, for treatment for treatment he he received received in in connection connection with with an an automobile automobile accident accident occurred on or which occurred about, 0r about, December December 4, 4, 2018, 201 8, were were not not entirely entirely reasonable reasonable and and necessary. necessary. Specifically: Specifically: My My name name is is Ryan Ryan Robinson, D.C., CCSP, Robinson, D.C., CCSP, II amam licensed licensed by by the the State State ofof Texas Texas as as aa Chiropractor. I have over 6 years of experience treating Chiropractor. I have over 6 years of experience treating patients patients as as aa chiropractor chiropractor in in the the DFW area, area, and and during the past during the past 66 plus plus years years II have have also also from from time time toto time time treated treated patients in 4 patients in 4 chiropractic clinics in Plano, Grapevine, Saginaw, chiropractic clinics in Plano, Grapevine, Saginaw, and and Fort Fort Worth, Worth, Texas. Texas. The The patients patientsJ,I have have treated treated include include hundreds hundreds of of patients patients with with complaints complaints ofof pain pain in in the the spine spine and and extremities extremities from from motor motor vehicle accidents. II completed vehicle accidents. completed aa post post graduate graduate certification certification in in sports sports in in November November of of 2015, 2015, which which enables enables meme to to diagnose diagnose and and treat treat traumatic traumatic injuries injuries more effectively. effectively. My My comments comments on on reasonable allowanceshere reasonable allowances here are are based based upon upon my my many many years year's of 0f experience experience inin treating treating patients patients with with such such conditions. conditions. Many of of the the patients patients II have dealt dealt with with and and deal deal with with daily daily have have high high deductibles deductibles and and it it has has been been necessary necessary forfor me to contact imaging centers to contact imaging centers and other and other providers providers to to ascertain ascertain what what would would be be the the most most appropriate appropriate referral referral pattern pattern for for my my patients, to assure they get quality care that they patients, to assure they get quality care that they can can afford. afford. As a a result, result, I I have have a strong strong idea idea of of reasonable reasonable charges charges for for the the services services on on which whichII comment. In In reference reference to t0 the the use use of 0faadetailed detailed exam, exam, the the CPT CPT Coding Coding Manual Manual requires requires three three key key . components: components: detailed detailed history, history, detailed detailed exam, exam, and moderate level and moderate level of of medical medical decision-making. decision-making. In In LARA LARA VS. VS. PINDI PINDI om PAGE20F6 19/1052 addition, the addition, the problem problem severity severity should should be be low, low, and and physician physician time time at at least least 30 30 minutes. minutes. From From the the documentationprovided, documentation provided,itit appears appearsthese these criteria criteriahave have been been met met and and the the service service is is therefore therefore necessary. necessary. In reference In reference to to the the x-rays x-rays performed performed on on this this claimant, claimant, based based on on the the mechanism of mechanism of injury injury and the and the claimant’s claimant's age, age, these these are are both both reasonable and necessary. reasonable and necessary. In reference In reference to to the the use use of 0f electrical muscle stimulation, electrical fnuscle stimulation, manual manual therapy, therapy, ultrasound, ultrasound, based based on my clinical experience, on my clinical experience, this this modality modality has has clinically clinically been been demonstrated demonstrated to to provide short-term shOIT-term pain relief pain relief and and increase increase spinal spinal mobility mobility to to facilitate facilitate spinal spinal manipulation. manipulation. Based Based onon the the article article entitled entitled "Philadelphia “Philadelphia Panel Panel evidence-based evidence-based clinical clinical practice practice guidelines guidelines on selected selected rehabilitation rehabilitatiou interventions for interventions for neck neck pain” pain" dated dated October October 2001, 2001, for for several several interventions interventions andand indications (eg, indications (cg, thermotherapy,therapeutic thermotherapy, therapeuticultrasound, ultrasound,massage, massage,electrical electricalstimulation), stimulation),there therewas wasaa lack lack of of evidence regarding evidence regarding efficacy. efficacy. Additionally, Additionally,inin my my professional professional opinion, opinion, if used, if used, would not be would not be recommended past recommended past 2-3 2-3 weeks weeks postpost initial initial presentation presentation to to the the treating treating doctor'. doctorl. Instead, Instead, patients patients should be weaned off passive therapies and transitioned should be weaned off passive therapies and transitioned into into active active care, care, as as the the use use of of active active care care is associated is with aa much associated with much better better clinical clinical outcome. outcome. Therefore, Therefore, reimbursement reimbursement is is only only reasonable and necessary for the first 3 weeks and necessary for the first 3 weeks of of treatment. treatment. In reference In to the reference t0 the use use of ofmechanical mechanical traction, traction, based based on 0n my my clinical clinical experience, experience, this this modality has clinically modality has clinically been been demonstrated demonstrated to to provide provide short-term short-term pain pain relief relief and increase spinal and increase spinal mobility mobility toto facilitate facilitate spinal spinal manipulation. manipulation. Based Based onon the the article article entitled entitled "Philadelphia “Philadelphia Panel Panel evidence-based evidence-based clinical clinical practice practice guidelines guidelines on0n selected rehabilitation interventions for neck pain” selected rehabilitation interventions for neck pain" dated dated October October 2001, 2001, studies studies have have concluded concluded there there is is limited limited documentation documentation of of efficacy efficacy of cervical traction beyond short-term pain reduction. In cervical traction beyond short-term pain reduction. In general, general, it it would would not not be advisable advisable to to use these modalities these modalities beyond beyond 2-32-3 weeks weeks ififsigns signsof of objective objectiveprogress progress towards towards functional functional restoration are not demonstrated'. Instead, restoration are not demonstrated‘. Instead, patients patients should should be weaned off passive passive therapies therapies and and transitioned into active transitioned into active care, care, as as the the use use of of active active care care isis associated associated with with aa much much better better clinical clinical outcome. Therefore, outcome. Therefore, reimbursement reimbursement is is only only reasonable reasonable and and necessary necessary up up to to the following following up to to the the first first 33 weeks weeks of of treatment. treatment. In In reference reference to to the the Chiropractic Chiropractic Adjustment, Adjustment, fr