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FILED
DALLAS COUNTY
1/7/2020 5:10PM
FELICIA PITRE
Darlinfis‘l‘fifiéflERK
CAUSE NO. DC-19-16913
RODNEY BROWN § IN THE DISTRICT COURT
Plaintiff, §
§
v. § 116m JUDICIAL DISTRICT
§
§
REYNALDO BAUTISTA AND §
IRMA BAUTISTA §
Defendants. § DALLAS COUNTY, TEXAS
DEFENDANT’S NOTICE OF FILING COUNTERAFFIDAVIT AND EXPERT
DESIGNATION
TO: ALL COUNSEL OF RECORD
Pursuant t0 Section 18.001(e) and Section 18.001(f) of the TEXAS CIVIL PRACTICE AND
REMEDIES CODE, you are hereby notified that Defendant has filed, With the Clerk 0f the Court,
controverting affidavits. Defendant further hereby furnishes an expert designation.
Specifically, Defendant filed the affidavit, attached hereto, Which is signed by Robert
Andrew Mott, D.C., said affidavits being as follows:
1) COUNTERAFFIDAVIT, PURSUANT T0 SECTION 18.001 0F THE TEXAS CIVIL PRACTICE AND
REMEDIES CODE CONCERNING THE REASONABLENESS AND NECESSITY 0F MEDICAL
SERVICES AND COSTS PROVIDED T0 RODNEY BROWN
Defendant intends t0 offer such affidavits t0 controvert the alleged necessity and
reasonableness of the medical services received by Plaintiff in the trial 0f the above-captioned
cause.
EXPERT DESIGNATION
Defendant also gives notice t0 all parties that the information contained in the attached Counter-
affidavit(s) supplements Defendant’s Responses t0 Plaintiff” s Request for Disclosure under Tex.
R. CiV. P. 194.2(f)(1)-(4) regarding experts Who might be called to testify at trial, as follows:
Name: Robert Andrew Mott, D.C.
Address: 2707 Kennedy Dr. Melissa, TX 75454
Telephone: 469-23 1-23 1 8
The expert(s) named above has reviewed Plaintiff” s medical records and documents
produced by Plaintiff in discovery, which are in Plaintiff s possession. The expert(s) may testify
about:
1. Plaintiff s medical condition, both before and after the accident in question;
2. Plaintiffs’ injuries, if any, reasonably associated With the accident made the basis of this
lawsuit;
3. The reasonableness 0r necessity of some or all of Plaintiff’s medical treatment that
Plaintiff received in the past 0r might be expected t0 receive in the fiJture resulting from
any injuries Plaintiff allegedly sustained as a result 0f the accident made the basis 0f this
lawsuit; and
4. The reasonableness 0f some or all 0f the cost 0f medical services that Plaintiff’ s received
in the past 0r might be expected t0 receive in the future resulting from any injuries
Plaintiff allegedly sustained as a result 0f the accident made the basis 0f this lawsuit.
A summary of the expected testimony is contained in the attached report(s) and/or
affidavit(s). The expert’s testimony Will be based 0n the expert’s education, training, and
experience as noted in the expert’s Curriculum Vitae attached to the expert’s affidavit.
Respectfully submitted,
CHAVEZ LEGAL GROUP
Fernando Martinez Jr.
State Bar No. 24070934
11900 N. 26th St, Suite 200
Edinburg TX 78539
(972) 419-3800 Telephone
(972) 239-5046 Facsimile
fmartinezjr@chavezlegalgroup.com
Attorney for the Defendant
CERTIFICATE OF SERVICE
This is to certify that on the _7th_ day 0f _January_, 2020, a true and correct copy of the
foregoing was forwarded to all parties and counsel 0f record as follows:
VIA EFILING: Wduke@duckeseth.com
Walker M. Duke
Duke Seth, P.L.L.C.
325 N. St. Paul Street, Suite 2220
Dallas, Texas 75201
Attorney for the Plaintiff
FERNANDO MARTINEZ, JR.
CAUSE NO. DC-19-16913
RODNEY BROWN IN THE DISTRICT COURT
PLAINTIFF,
VS. DALLAS COUNTY, TEXAS
REYNALDO BAUTISTA, and
IRMA BAUTISTA,
116th JUDICIAL DISTRICT
DEFENDANT(S).
COUNTERAFFIDAVIT, PURSUANT TO SECTION 18.001 OF THE TEXAS CIVIL
PRACTICE AND REMEDIES CODE CONCERNING THE REASONABLENESS AND
NECESSITY OF MEDICAL SERVICES AND COSTS PROVIDED T0
RODNEY BROWN
BEFORE ME, the undersigned authority, on this day personally appeared Robert-Andrew
Mott, D.C. who, after being duly sworn, deposed as follows:
“My name is Robert Andrew Mott, D.C. I am over the age of 21, of sound mind, and
capable of making this affidavit. The facts stated in this affidavit are within my personal
knowledge and are true and correct. I am a Doctor of Chiropractic, licensed to practice in the
State of Texas. Please see my curriculum vitae attached hereto, and incorporated herein, by
reference, as Exhibit A.
I am a person qualified by knowledge, skill, experience, training, and education, to
provide an opinion in contravention to the affidavits regarding the cost and necessity of the
medical services provided to Rodney Brown, in that I have treated numerous patients involved in
motor vehicle and other accidents over the years. I received my Doctor of Chiropractic degree
from Parker College of Chiropractic in 2004.
During my time as a licensed and practicing Chiropractor since 2004, I have become
familiar with billing practices and medical services of chiropractors in the State of Texas. My
knowledge, skill, experience, education, and training allow me to determine what medical
services are medically necessary, medically related, and/or medically justified. Moreover, my
knowledge, skill,experience, education, and training allow me to determine the cost of medical
services provided that are reasonable and whether the medical services provided were necessary.
PAGE 1 0F 5
BROWN. VS.BA UTISTA, ETAL.
I have personally reviewed the medical and billing records regarding Rodney Brown. I
did not examine Mr. Brown. I am familiar with the type of injury allegedly incurred by Mr.
Brown through my review of the medical records from the above-stated medical service
providers listed herein. *
I reviewed the following records:
Legal Documents
Chiropractic Healthcare Center;
North Texas X—Ray Services, Inc.;
MRI Centers of Texas;
“399993.“?
MDN Injury Care;
Foundation Physicians Group;
Foundation Surgery;
Bills/Invoices: Chiropractic Healthcare Center; Health Insurance Claim Forms
(MDN Business and MRI Centers of Texas); ASP Cares; JTP Diagnostics, LLC;
Foundations Physician; Salient Radiology.
Based on my knowledge, skill, experience, training, and education, I have formed the
following opinion:
The chiropractic and diagnostics services Rodney Brown those costs associated with
them, for treatment he received in connection with an automobile accident which occurred on or
about, December 20, 2017, were not entirely reasonable and necessary.
Specifically:
My name isRobert Mott, D.C. Iam licensed by the state of Texas as a Chiropractor, I
have 15 years of experience treating patients as a Chiropractor in the DFW area. Ihave practiced
in McKinney since 2006. I also have previously been a Designated Doctor in the state of Texas
for the past year, traveling around the state of Texas for purposes of evaluating injury cases, I
also have an additional certification in acupuncture and I am a certified medical examiner in the
National Registry of Certified Medical Examiners for the purpose of conducting DOT physicals.
In my 15 years of experience, I have treated well over ten thousand patients with complaints of
pain in the spine and extremities from motor vehicle accidents or other injuries. I commonly
coordinate care with other specialists to ensure quality and efficiency of care for the patient. lam
experienced with the costs involved with accident cases and treatments that are associated with
these cases.
PAGE 2 0F 5
BRO WN. VS.BA UTISTA, ETAL.
My comments on reasonable and necessaxy allowances are based upon my years of
experience in treating injury patients. I regularly coordinate care with imaging centers and other
providers to assure my patients get the quality care they can afford. Iam very familiar with fee
schedules for common treatment codes around the area. Reasonable and necessary charge
recommendations are based upon usual and customary fees around the region.
The claimant was unemployed at the time of the accident. Work status was not
interrupted 0r affected by the injuries reviewed.
In my professional opinion based on the records available, the injuries reviewed were
proximally caused by the motor vehicle accident on December 20, 2017.
In my professional opinion, and based on a reasonable degree of medical probability, the
claimant will not require any additional chiropractic treatment, nor will he have any future
physical impairments secondary to the injuries sustained in the motor vehicle accident on
December 20, 2017.
From the documentation provided, the claimant did not have any pre—existing conditions,
nor was there any aggravation by the motor vehicle accident.
In reference to the use of a detailed exam, the CPT Coding Manual requires three key
components: detailed history, detailed exam, and low level of medical decision-making. In
addition, the problem severity should be moderate, and physician time at least thirty minutes.
From the documentation provided, it appears these criteria have been met and the service is
therefore necessary.
In reference t0 the chiropractic adjustment, from my experience with the diagnosis of this
claimant, a trial period of treatment consisting of 6-8 visits in a time period 0f 2-3 weeks has
been indicated to provide an adequate sample of the success of the treatment. If the chiropractor
can demonstrate objective functional improvement during the trialperiod, then up to 18-22
treatments over a period of 6 weeks isrecommended. In this case, there was objective functional
improvement during the trial period of care. Therefore, this service was both reasonable and
necessary for the first 22 dates of service and the final date of service should be on February 23,
2018.
In reference t0 the use of electrical muscle stimulation, based on my clinical experience,
this modality has clinically been demonstrated to provide short-term pain relief and increase
spinal mobility to facilitate spinal manipulation. However, the use of passive modalities isnot
recommended beyond the second week of treatment as it may lead to patient and provider
dependence. Instead, patients should be weaned off passive therapies and transitioned into active
care, as the use of active care is associated with a much better clinical outcome. Therefore,
PAGE 3 0F 5
BRO WN. VS.BA UTISTA, ETAL.
reimbursement is only reasonable and necessary for the first two weeks of treatment and the final
date of this modality should be on January 11, 2018.
In reference to the use of ultrasound therapy, based 0n my clinical experience, this
modality has clinically been demonstrated to provide short-term pain relief and increase spinal
mobility and decrease swelling. However, the use of passive modalities is not recommended
beyond the second week of treatment as it may lead to patient and provider dependence. Instead,
patients should be weaned off passive therapies and transitioned into active care, as the use of
active care is associated with a much better clinical outcome. Therefore, reimbursement is
reasonable and necessary for the first two weeks of treatment, and all three billed dates of
ultrasound, and the final date of service should be on January 11, 2018.
In reference to the use of Manual Therapy, based on my clinical experience with soft
tissue related injuries, I recommend up to 6 sessions over the first 2 weeks of treatment. This
modality has demonstrated to be effective in improving muscle spasms, improving patient
mobility, and improving spinal range of motion. However, the use of passive therapies is not
recommended beyond the second week of treatment as it may lead to patient and provider
dependence. Instead, patients should be weaned off passive therapies and transitioned into active
care, as the use of active care is associated with a much better clinical outcome. Therefore,
reimbursement isonly reasonable and necessary for the first 2 weeks of treatment and the final
date 0f service should be on January 11, 2018.
In reference to the use of hot/cold packs, based on my clinical experience With soft tissue
related injuries, I recommend up to six sessions over the first two weeks of treatment. This
treatment has demonstrated to be effective in decreasing swelling, increasing circulation, and
having analgesic effects. However, the use of passive therapies is not recommended beyond the
second week of treatment as it may lead to patient and provider dependence. Instead the patient
should be educated on proper usage of hot/cold packs at home. Therefore, reimbursement is
only reasonable and necessary for the first two weeks of treatment and the final date of service
should be on January 11, 2018.
In reference to the use of a detailed re—exam, the CPT Coding Manual requires three key
components: detailed history, detailed exam, and moderate level of medical decision-making. In
addition, the problem severity should be moderate, and physician time at least thirty minutes.
From the documentation provided, it appears these criteria have been met and the service is
necessary on February 12, 2018.
In reference to the use of mechanical traction therapy, based on my clinical experience
with soft tissue related injuries, I recommend up to six sessions over the first two weeks of
treatment. This modality has demonstrated to be effective in increasing patient mobility and
spinal range of motion, However, the use of passive modalities is not recommended beyond the
PAGE 4 0F 5
BROWN. VS.BA UTISTA, ETAL.
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EXHIBIT A
01/29/2019
l
Robert Andrew Mofl DC
2707 Kennedy Dr.
Melissa, TX 75454
469-231 -23]8
drmofl@proacfivemckinney.com
EDUCATION:
BoChelor of Ar’rs, J999.
Texas Tech University
Doctor of Chiropractic, 2004.
Parker College of Chiropractic
Certified Acupuncture, 2004.‘
in
,,
Parker College of Chiropractic
Licensed by Texas Board of Chiropractic Examiners
Currently
-
License #9758
’ro
Medical Examiner Federal Mdtor Carrier Safety Administration
Certified ‘
perform DOT physical exams 2013.
Designated Doctor Certification 201 7-.
Texas Department of Insurance
RELATED EXPERIENCE:
Texas Degartmenf of Insurance Designated Doctor:
'
Designated Doctor .
Texas, 201 7— Present
0nd assign on impairment rating” 0nd maximum
-Ev~o‘|uo’re employee injuries
_
medical improvement determination using MDG 0nd ODG guidelines.
relo’res To Their ability To return To
-Evoluofe employee current conditions'os '
if
'
'
- >
work.
Chirogracfic Wellness Center:
Co—Owner, Chiropractor
McKinney, TX 11-/2015—P_resen1
l'
cdre using evidence based medicine via The
-Pvrovid'e outstanding chiropractic '
MDG 0nd ODG guidelines.
monogeriol'cmd administrative duties including sched uling, payroll,
-Doy ’ro day
0nd accounting. Managing o staff of six employees.
inventory,
care providers about the benefits of
-Educofing patients and area healfh
care and The roie of chiropractic docfors in The welln ess and acute
chiropractic
core sefiings.
histories, performing reievonf
—Work cs o chiropractor Taking clinical
laboratories 0nd diagnostic imaging,
examinations, ordering 0nd interpreting
report of findings To bofh
developing Treatment plans, cleofly communicating '
The patient 0nd referring physicians.
.using
chiropracfic adjustments to both the axial spine 0nd extremities
Delivering
acupuncture, and physio—theropy 10 achieve
on array of Techniques, employing '
, objective clinical goals.
needle acupuncture, elecfro acupuncture, 0nd
-Ufilizi-ng sterile Technique
increase range of motion, 0nd impro ve clinic al
acupressure to reduce pain,
outcomes for patients.
outcomes using OSWESTRY disability indices.
-Trocking clinical
pofien’rs ’ro appropriate providers cs necessary.
—Referring
on current clinical, scientific, legal, ethical, 0nd legislative
ésfoyjng up To date
‘even’rs ‘rhon‘affect The chiropractic profession.
examinations 0nd evaluations as
-Performing mandated CDL physical
mandated by the FMCSA.
Chirogracfic 8. Acupuncture:
Proactive
CEO, ChirOprcctor
McKin ney, TX O1 /2005-1 1/20] 5
administrative duties including séheduling, payroll,
-Doy to day monogerial and
inven’rory, 0nd accounting.
about The benefits of
-Educofing patients 0nd oreo helo core providers
chiropractic doctors in The wellness 0nd acute
chiropractic core, 0nd the role of
core se’rfingsi
clinical histories, performing relevant
-
-Work as sole chiropractor faking
laboratories 0nd diagnostic imaging,
examinations, ordering 0nd interpreting
Of findings to bo’rh
developing Treatment plans, ‘clecr-ly commonicofing report
'
the pofient 0nd referring“ physicians. .
Delivering chiropractic adjustments To bo’rh ’rhe axial spine 0nd extremities using
acupuncture, and p‘hysio—Thera’py To achieve
on orroy of Techniques, employing ’ ’
-
objective clinical goals.
technique heedle acupuncture, elecfro acupuncture, 0nd
-U’ri|izing sterile
acupressure ’roreduce pain, increase range of motion, 0nd improve clinical
'
'
outcomes for pa’rienTs.‘
’
clinical outcomes using OSWESTRY disability indices.
>—Tr'ocl
Preview
FILED DALLAS COUNTY 1/7/2020 5:10PM FELICIA PITRE Darlinfis‘l‘fifiéflERK CAUSE NO. DC-19-16913 RODNEY BROWN § IN THE DISTRICT COURT Plaintiff, § § v. § 116m JUDICIAL DISTRICT § § REYNALDO BAUTISTA AND § IRMA BAUTISTA § Defendants. § DALLAS COUNTY, TEXAS DEFENDANT’S NOTICE OF FILING COUNTERAFFIDAVIT AND EXPERT DESIGNATION TO: ALL COUNSEL OF RECORD Pursuant t0 Section 18.001(e) and Section 18.001(f) of the TEXAS CIVIL PRACTICE AND REMEDIES CODE, you are hereby notified that Defendant has filed, With the Clerk 0f the Court, controverting affidavits. Defendant further hereby furnishes an expert designation. Specifically, Defendant filed the affidavit, attached hereto, Which is signed by Robert Andrew Mott, D.C., said affidavits being as follows: 1) COUNTERAFFIDAVIT, PURSUANT T0 SECTION 18.001 0F THE TEXAS CIVIL PRACTICE AND REMEDIES CODE CONCERNING THE REASONABLENESS AND NECESSITY 0F MEDICAL SERVICES AND COSTS PROVIDED T0 RODNEY BROWN Defendant intends t0 offer such affidavits t0 controvert the alleged necessity and reasonableness of the medical services received by Plaintiff in the trial 0f the above-captioned cause. EXPERT DESIGNATION Defendant also gives notice t0 all parties that the information contained in the attached Counter- affidavit(s) supplements Defendant’s Responses t0 Plaintiff” s Request for Disclosure under Tex. R. CiV. P. 194.2(f)(1)-(4) regarding experts Who might be called to testify at trial, as follows: Name: Robert Andrew Mott, D.C. Address: 2707 Kennedy Dr. Melissa, TX 75454 Telephone: 469-23 1-23 1 8 The expert(s) named above has reviewed Plaintiff” s medical records and documents produced by Plaintiff in discovery, which are in Plaintiff s possession. The expert(s) may testify about: 1. Plaintiff s medical condition, both before and after the accident in question; 2. Plaintiffs’ injuries, if any, reasonably associated With the accident made the basis of this lawsuit; 3. The reasonableness 0r necessity of some or all of Plaintiff’s medical treatment that Plaintiff received in the past 0r might be expected t0 receive in the fiJture resulting from any injuries Plaintiff allegedly sustained as a result 0f the accident made the basis 0f this lawsuit; and 4. The reasonableness 0f some or all 0f the cost 0f medical services that Plaintiff’ s received in the past 0r might be expected t0 receive in the future resulting from any injuries Plaintiff allegedly sustained as a result 0f the accident made the basis 0f this lawsuit. A summary of the expected testimony is contained in the attached report(s) and/or affidavit(s). The expert’s testimony Will be based 0n the expert’s education, training, and experience as noted in the expert’s Curriculum Vitae attached to the expert’s affidavit. Respectfully submitted, CHAVEZ LEGAL GROUP Fernando Martinez Jr. State Bar No. 24070934 11900 N. 26th St, Suite 200 Edinburg TX 78539 (972) 419-3800 Telephone (972) 239-5046 Facsimile fmartinezjr@chavezlegalgroup.com Attorney for the Defendant CERTIFICATE OF SERVICE This is to certify that on the _7th_ day 0f _January_, 2020, a true and correct copy of the foregoing was forwarded to all parties and counsel 0f record as follows: VIA EFILING: Wduke@duckeseth.com Walker M. Duke Duke Seth, P.L.L.C. 325 N. St. Paul Street, Suite 2220 Dallas, Texas 75201 Attorney for the Plaintiff FERNANDO MARTINEZ, JR. CAUSE NO. DC-19-16913 RODNEY BROWN IN THE DISTRICT COURT PLAINTIFF, VS. DALLAS COUNTY, TEXAS REYNALDO BAUTISTA, and IRMA BAUTISTA, 116th JUDICIAL DISTRICT DEFENDANT(S). COUNTERAFFIDAVIT, PURSUANT TO SECTION 18.001 OF THE TEXAS CIVIL PRACTICE AND REMEDIES CODE CONCERNING THE REASONABLENESS AND NECESSITY OF MEDICAL SERVICES AND COSTS PROVIDED T0 RODNEY BROWN BEFORE ME, the undersigned authority, on this day personally appeared Robert-Andrew Mott, D.C. who, after being duly sworn, deposed as follows: “My name is Robert Andrew Mott, D.C. I am over the age of 21, of sound mind, and capable of making this affidavit. The facts stated in this affidavit are within my personal knowledge and are true and correct. I am a Doctor of Chiropractic, licensed to practice in the State of Texas. Please see my curriculum vitae attached hereto, and incorporated herein, by reference, as Exhibit A. I am a person qualified by knowledge, skill, experience, training, and education, to provide an opinion in contravention to the affidavits regarding the cost and necessity of the medical services provided to Rodney Brown, in that I have treated numerous patients involved in motor vehicle and other accidents over the years. I received my Doctor of Chiropractic degree from Parker College of Chiropractic in 2004. During my time as a licensed and practicing Chiropractor since 2004, I have become familiar with billing practices and medical services of chiropractors in the State of Texas. My knowledge, skill, experience, education, and training allow me to determine what medical services are medically necessary, medically related, and/or medically justified. Moreover, my knowledge, skill,experience, education, and training allow me to determine the cost of medical services provided that are reasonable and whether the medical services provided were necessary. PAGE 1 0F 5 BROWN. VS.BA UTISTA, ETAL. I have personally reviewed the medical and billing records regarding Rodney Brown. I did not examine Mr. Brown. I am familiar with the type of injury allegedly incurred by Mr. Brown through my review of the medical records from the above-stated medical service providers listed herein. * I reviewed the following records: Legal Documents Chiropractic Healthcare Center; North Texas X—Ray Services, Inc.; MRI Centers of Texas; “399993.“? MDN Injury Care; Foundation Physicians Group; Foundation Surgery; Bills/Invoices: Chiropractic Healthcare Center; Health Insurance Claim Forms (MDN Business and MRI Centers of Texas); ASP Cares; JTP Diagnostics, LLC; Foundations Physician; Salient Radiology. Based on my knowledge, skill, experience, training, and education, I have formed the following opinion: The chiropractic and diagnostics services Rodney Brown those costs associated with them, for treatment he received in connection with an automobile accident which occurred on or about, December 20, 2017, were not entirely reasonable and necessary. Specifically: My name isRobert Mott, D.C. Iam licensed by the state of Texas as a Chiropractor, I have 15 years of experience treating patients as a Chiropractor in the DFW area. Ihave practiced in McKinney since 2006. I also have previously been a Designated Doctor in the state of Texas for the past year, traveling around the state of Texas for purposes of evaluating injury cases, I also have an additional certification in acupuncture and I am a certified medical examiner in the National Registry of Certified Medical Examiners for the purpose of conducting DOT physicals. In my 15 years of experience, I have treated well over ten thousand patients with complaints of pain in the spine and extremities from motor vehicle accidents or other injuries. I commonly coordinate care with other specialists to ensure quality and efficiency of care for the patient. lam experienced with the costs involved with accident cases and treatments that are associated with these cases. PAGE 2 0F 5 BRO WN. VS.BA UTISTA, ETAL. My comments on reasonable and necessaxy allowances are based upon my years of experience in treating injury patients. I regularly coordinate care with imaging centers and other providers to assure my patients get the quality care they can afford. Iam very familiar with fee schedules for common treatment codes around the area. Reasonable and necessary charge recommendations are based upon usual and customary fees around the region. The claimant was unemployed at the time of the accident. Work status was not interrupted 0r affected by the injuries reviewed. In my professional opinion based on the records available, the injuries reviewed were proximally caused by the motor vehicle accident on December 20, 2017. In my professional opinion, and based on a reasonable degree of medical probability, the claimant will not require any additional chiropractic treatment, nor will he have any future physical impairments secondary to the injuries sustained in the motor vehicle accident on December 20, 2017. From the documentation provided, the claimant did not have any pre—existing conditions, nor was there any aggravation by the motor vehicle accident. In reference to the use of a detailed exam, the CPT Coding Manual requires three key components: detailed history, detailed exam, and low level of medical decision-making. In addition, the problem severity should be moderate, and physician time at least thirty minutes. From the documentation provided, it appears these criteria have been met and the service is therefore necessary. In reference t0 the chiropractic adjustment, from my experience with the diagnosis of this claimant, a trial period of treatment consisting of 6-8 visits in a time period 0f 2-3 weeks has been indicated to provide an adequate sample of the success of the treatment. If the chiropractor can demonstrate objective functional improvement during the trialperiod, then up to 18-22 treatments over a period of 6 weeks isrecommended. In this case, there was objective functional improvement during the trial period of care. Therefore, this service was both reasonable and necessary for the first 22 dates of service and the final date of service should be on February 23, 2018. In reference t0 the use of electrical muscle stimulation, based on my clinical experience, this modality has clinically been demonstrated to provide short-term pain relief and increase spinal mobility to facilitate spinal manipulation. However, the use of passive modalities isnot recommended beyond the second week of treatment as it may lead to patient and provider dependence. Instead, patients should be weaned off passive therapies and transitioned into active care, as the use of active care is associated with a much better clinical outcome. Therefore, PAGE 3 0F 5 BRO WN. VS.BA UTISTA, ETAL. reimbursement is only reasonable and necessary for the first two weeks of treatment and the final date of this modality should be on January 11, 2018. In reference to the use of ultrasound therapy, based 0n my clinical experience, this modality has clinically been demonstrated to provide short-term pain relief and increase spinal mobility and decrease swelling. However, the use of passive modalities is not recommended beyond the second week of treatment as it may lead to patient and provider dependence. Instead, patients should be weaned off passive therapies and transitioned into active care, as the use of active care is associated with a much better clinical outcome. Therefore, reimbursement is reasonable and necessary for the first two weeks of treatment, and all three billed dates of ultrasound, and the final date of service should be on January 11, 2018. In reference to the use of Manual Therapy, based on my clinical experience with soft tissue related injuries, I recommend up to 6 sessions over the first 2 weeks of treatment. This modality has demonstrated to be effective in improving muscle spasms, improving patient mobility, and improving spinal range of motion. However, the use of passive therapies is not recommended beyond the second week of treatment as it may lead to patient and provider dependence. Instead, patients should be weaned off passive therapies and transitioned into active care, as the use of active care is associated with a much better clinical outcome. Therefore, reimbursement isonly reasonable and necessary for the first 2 weeks of treatment and the final date 0f service should be on January 11, 2018. In reference to the use of hot/cold packs, based on my clinical experience With soft tissue related injuries, I recommend up to six sessions over the first two weeks of treatment. This treatment has demonstrated to be effective in decreasing swelling, increasing circulation, and having analgesic effects. However, the use of passive therapies is not recommended beyond the second week of treatment as it may lead to patient and provider dependence. Instead the patient should be educated on proper usage of hot/cold packs at home. Therefore, reimbursement is only reasonable and necessary for the first two weeks of treatment and the final date of service should be on January 11, 2018. In reference to the use of a detailed re—exam, the CPT Coding Manual requires three key components: detailed history, detailed exam, and moderate level of medical decision-making. In addition, the problem severity should be moderate, and physician time at least thirty minutes. From the documentation provided, it appears these criteria have been met and the service is necessary on February 12, 2018. In reference to the use of mechanical traction therapy, based on my clinical experience with soft tissue related injuries, I recommend up to six sessions over the first two weeks of treatment. This modality has demonstrated to be effective in increasing patient mobility and spinal range of motion, However, the use of passive modalities is not recommended beyond the PAGE 4 0F 5 BROWN. 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Mini swim ‘ inmmm at: bait. §;>?-.:ami {éb» 1 ~: army, x; 2-5.; i6271.‘":'§x¢: 5:33p}? :2: :r,. _ firs: mass:- 3:gatspzmésti fl " i‘di‘ii???$prny.13.)3:..1‘Iiv.- “‘i haw mmmai mimmiuc: gr? mrfiw 3:22:86“ mu} iiiaga‘aésr;aha: yairs, {mic '25:}? am cmsrs‘fictg“ .§'?‘¥:'.f?§§’§"§§§ zifi’if’izam v32: ma; fga.:~;-é:3::'§:i muwi‘fix s2 “m. 3192126. EXHIBIT A 01/29/2019 l Robert Andrew Mofl DC 2707 Kennedy Dr. Melissa, TX 75454 469-231 -23]8 drmofl@proacfivemckinney.com EDUCATION: BoChelor of Ar’rs, J999. Texas Tech University Doctor of Chiropractic, 2004. Parker College of Chiropractic Certified Acupuncture, 2004.‘ in ,, Parker College of Chiropractic Licensed by Texas Board of Chiropractic Examiners Currently - License #9758 ’ro Medical Examiner Federal Mdtor Carrier Safety Administration Certified ‘ perform DOT physical exams 2013. Designated Doctor Certification 201 7-. Texas Department of Insurance RELATED EXPERIENCE: Texas Degartmenf of Insurance Designated Doctor: ' Designated Doctor . Texas, 201 7— Present 0nd assign on impairment rating” 0nd maximum -Ev~o‘|uo’re employee injuries _ medical improvement determination using MDG 0nd ODG guidelines. relo’res To Their ability To return To -Evoluofe employee current conditions'os ' if ' ' - > work. Chirogracfic Wellness Center: Co—Owner, Chiropractor McKinney, TX 11-/2015—P_resen1 l' cdre using evidence based medicine via The -Pvrovid'e outstanding chiropractic ' MDG 0nd ODG guidelines. monogeriol'cmd administrative duties including sched uling, payroll, -Doy ’ro day 0nd accounting. Managing o staff of six employees. inventory, care providers about the benefits of -Educofing patients and area healfh care and The roie of chiropractic docfors in The welln ess and acute chiropractic core sefiings. histories, performing reievonf —Work cs o chiropractor Taking clinical laboratories 0nd diagnostic imaging, examinations, ordering 0nd interpreting report of findings To bofh developing Treatment plans, cleofly communicating ' The patient 0nd referring physicians. .using chiropracfic adjustments to both the axial spine 0nd extremities Delivering acupuncture, and physio—theropy 10 achieve on array of Techniques, employing ' , objective clinical goals. needle acupuncture, elecfro acupuncture, 0nd -Ufilizi-ng sterile Technique increase range of motion, 0nd impro ve clinic al acupressure to reduce pain, outcomes for patients. outcomes using OSWESTRY disability indices. -Trocking clinical pofien’rs ’ro appropriate providers cs necessary. —Referring on current clinical, scientific, legal, ethical, 0nd legislative ésfoyjng up To date ‘even’rs ‘rhon‘affect The chiropractic profession. examinations 0nd evaluations as -Performing mandated CDL physical mandated by the FMCSA. Chirogracfic 8. Acupuncture: Proactive CEO, ChirOprcctor McKin ney, TX O1 /2005-1 1/20] 5 administrative duties including séheduling, payroll, -Doy to day monogerial and inven’rory, 0nd accounting. about The benefits of -Educofing patients 0nd oreo helo core providers chiropractic doctors in The wellness 0nd acute chiropractic core, 0nd the role of core se’rfingsi clinical histories, performing relevant - -Work as sole chiropractor faking laboratories 0nd diagnostic imaging, examinations, ordering 0nd interpreting Of findings to bo’rh developing Treatment plans, ‘clecr-ly commonicofing report ' the pofient 0nd referring“ physicians. . Delivering chiropractic adjustments To bo’rh ’rhe axial spine 0nd extremities using acupuncture, and p‘hysio—Thera’py To achieve on orroy of Techniques, employing ’ ’ - objective clinical goals. technique heedle acupuncture, elecfro acupuncture, 0nd -U’ri|izing sterile acupressure ’roreduce pain, increase range of motion, 0nd improve clinical ' ' outcomes for pa’rienTs.‘ ’ clinical outcomes using OSWESTRY disability indices. >—Tr'ocl