Disciplinary Action against Mary D. Holland, D.C.
Stephen Barrett, M.D.
In 2006, Mary Holland, D.C. was disciplined by the Virginia Board of Medicine. which regulates chiropractors as well as medical doctors in Virginia. After reviewing more than 30 patient records, the board concluded that (a) many of her records were incomplete, (b) in many cases, her clinical notes failed to support her billing records, (c) in most cases, she sold supplement products to patients without documenting the reasons for recommending them, (d) in several cases, she sold other supplies to patients who didn't need them, (e) in several cases, she billed insurance companies for visits that were not documented in her records, (f) in a few cases, she failed to issue refunds that were due to patients, and (g) when describing patient complaints in her daily notes, records, and insurance billings, often used complicated and unsupported diagnoses to justify extensive treatment. In addition, several employees told the board that Dr. Holland had instructed them to exaggerate findings in spinal screenings as a way to obtain new patients. The case was settled with a consent order (shown below) that suspended her license for a minimum of four years, after which she could petition for reinstatement if she believed she was fit to resume practice. Her license was reinstated in 2011.
BEFORE THE BOARD OF MEDICINE
IN RE: MARY DARLENE HOLLAND, D.C.
License No.: 0104-000502
By letter dated May 5, 2006, the Virginia Board of Medicine ("Board") noticed Dr. Holland for a formal administrative hearing to inquire into allegations that she may have violated certain laws governing the practice of chiropractic in the Commonwealth of Virginia.
In lieu of proceeding to this formal hearing, the Board and Dr. Holland, as evidenced by their signatures affixed below, agree to enter into this Consent Order affecting the license of Dr. Holland to practice chiropractic in Virginia.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
The Board adopts the following findings and conclusions in this matter:
1. Dr. Holland was issued license number 0104-000502 by the Board to practice chiropractic in the Commonwealth of Virginia on August 15, 1984. Said license will expire on January 31, 2008, unless renewed or otherwise restricted.
2. Dr. Holland violated Sections 54.1-2915.A (1), (13), and (16) [formerly Sections 54.1-2915.A (1) and 54.1-2914.A (8) and (11)] of the Code, in that:
a. Dr. Holland failed to notify Patients E and F that they were due refunds on services performed from 1996 to 1999 for which they had overpaid. Patients E and F obtained a copy of their billing records from Dr. Holland, which indicated that they were due refunds. Additionally, billing records for Patient E obtained by subpoena show marked differences and were significantly more extensive from the same records Dr. Holland gave to Patient E.
b. Dr. Holland's clinical records often fail to support her billing records. At various times from November 1995 through July 2000, for Patients E, H, J, K, N, O, P, Q, R, T, FF, and LL, she failed to document patient visits, yet she billed insurance companies or patients for services.
c. From about August 1998 to January 1999, staff members stated that Dr. Holland instructed them to exaggerate findings in spinal screenings as a way to obtain new patients.
d. Between on or about October 21, 1998 and February 11, 1999, according to an employee, Dr. Holland directed her to alter a telephone log to document pre-authorization in order to obtain insurance reimbursement.
e. From about April 1991 through April 2004, Dr. Holland's description of patient complaints in her daily notes, records, and insurance billings used complicated and unsupported diagnoses to justify extensive treatment on multiple patients.
f. From about September 1997 through May 2000, Dr. Holland failed to enter patients' daily notes contemporaneously, with some patient files (refer to 2b above) without notes for every visit, some with only the names written on the daily note, as with Patients E, J, O, Q, R, W, EE, and FF, and patients with two or more different notes written for the same date of service, as with Patients H, O, Q, X, and FF.
g. From about July 1991 through December 1999, Dr. Holland failed to properly adjust Patients B, MM, OO, PP, and SS accounts for amounts billed over the allowable charges or denied by insurance with no patient responsibility.
h. From about September 1992 to about May 2000, Dr. Holland conducted laboratory testing on Patients E, O, LL, and OO, ordered a magnetic resonance imaging ("MRI") test for Patient H, and conducted computerized strength testing on Patients B, H, N, O, P, JJ, MM, and OO, without documenting a clinical necessity for such testing.
i. On or about September 22, 2004, Dr. Holland had Patient TT sign her "Anthem/Trigon/Blue Cross-Blue Shield Waiver," which stated that Anthem/Trigon had asked Dr. Holland to have their patients sign the form and that they would be responsible for non-covered services, including ice and heat treatments. An Anthem representative stated that she had previously informed Dr. Holland that patients were not liable for such services with or without a waiver. Nevertheless, on or about January 21, 2005, Dr. Holland charged Patient TT for seven (7) hot/ cold packs. However, Dr. Holland states that she received conflicting information from Anthem.
3. Dr. Holland violated Sections 54.1-2915.A (3), (13), and (16) [formerly Sections 1-2915.A (4) and 54.1-2914.A (8), and (11)] of the Code, in that:
a. On or before February 15, 2000, Dr. Holland failed to provide clean blankets for incoming patients. Blankets found in the treatment rooms were observed to have stains and hairs on them.
b. On or before February 7, 2000, some of the single-use ice packs that Dr. Holland reused leaked, resulting in chemical burns to some of her patients and staff.
c. From approximately August 1998 to January 1999, Dr. Holland failed to have staff members wear radiation badges or have them available when taking x-rays.
d. From sometime prior to February 2000 to at least October 2003, Dr. Holland failed to maintain order in her office, such that patient records were frequently in disarray or could not be located when needed by office staff or requested by the Investigator from the Department of Health Professions ("Investigator").
e. In January 2004, during an examination of thirty-four (34) patient files, it was found that Dr. Holland had information belonging to other patients in at least seven (7) of the 34 records. Patients F, H, I, O, R, X, and LL held clinical or financial records relating to other patients.
f. Dr. Holland failed to maintain adequate clinical records during the course of her treatment of Patients A-Z and AA-TT from at least 1991 to the present. The clinical records are haphazardly recorded, not systematic or thorough, and reflect omissions when documenting observations, assessments and treatment plans, making it difficult to follow the course of the patients' treatments. Some records for treatment dates are missing.
4. Dr. Holland violated Sections 54.1-2915.A (3), (11), (13), and (16) [formerly Sections 54.1-2915.A (4) and 54.1-2914.A (6), (8), and (11)] of the Code, in that, from on or about August 1998 to February 2000, she allowed unlicensed individuals to perform discretionary duties without proper supervision.
5. From about November 1992 to about October 2004, Dr. Holland violated Sections 54.1-2915.A (1), (3), (16), and (18) [formerly Sections 54.1-2915 (1), (3), (11) and (13)], as further defined by Section 54.1-2914.B [formerly Section 54.1-2914.CJ of the Code, in that she sold medical appliances, including, but not limited to, cervical collars and lumbar supports to Patients B, E, H, I, K, M, N, O, P, Q, R, V, Z, EE, FF, II, JJ, LL, MM, NN, OO, PP, QQ, and SS without supporting documentation of clinical necessity in her patient record.
6. From about January 1993 to about October 2004, Dr. Holland violated Sections 54.1-2915.A (1), (13), (16), and (18) [formerly Sections 54.1-2915.A (1) and 54.1-2914.A (8), (11), and (13)] of the Code, and 18 VAC 85-20-40 (A) of the Regulations of the Board of Medicine ("Regulations"), in that she sold vitamins, minerals and food supplements, including, but not limited to, Glycoplex, Livaplex, Drenamin, Colorad, Mucoplex, Circuplex, Min-Tran, K-B Plus(T), Lullaby, and Muconell, to Patients B, E, F, H, I, J, K, M, N, O, P, Q, R, U, Z, EE, FF, JJ, LL. MM, NN, OO, QQ, PP, RR, and SS without documenting the use or recommendation of these products and her rationale for their use or recommendation in the clinical records. Additionally, Dr. Holland failed to provide evidence to the Investigator on or about February 15, 2000, April 23, 2000, and April 23, 2002, and by Subpoena Duces Tecum on or about June 12, 2000, that these vitamins, minerals and food supplements are therapeutically proven and not experimental.
7. During approximately August 1999, Dr. Holland violated Section 54.1-2915.A (13), (16), and (18) [formerly Sections 54.1-2915.A (3) and.1-2914.A (8), (11), and (13)] of the Code and 18 VAC 85-20-30.B of the Regulations, in that, within 72 hours of the initial office visit that resulted from a discounted or free service, examination or treatment, she charged Patients B, T, U, V, W, X, Z, AA, FF, and 00 for additional services, examinations or treatments.
8. Dr. Holland violated Section 54.1-2915.A (18) [formerly Section 54.1-2914.A (13)] of the Code and 18 VAC 85-20-105 of the Regulations, in that:
a. Following requests by the Investigator on or about February 15, 2000, and on or about April 23, 2000, and a Subpoena Duces Tecum served June 12, 2000, Dr. Holland failed provide the following documents: clinical records for Patients E, F, G and N; a statement explaining her rationale for selling nutritional supplements to Patients E, F, and G; a statement supporting the necessity for multiple cervical supports for Patients E and F; a list of patients that came to her practice as a result of screenings at a local shopping mall; and a statement explaining her training and assigning of unlicensed staff to perform physical therapies.
b. On or about September 4, 2001, Dr. Holland failed to provide Patient G's clinical records upon request by the Investigator.
c. In an interview with the Investigator on or about April 23, 2002, Dr. Holland again failed to provide the statement of rationale regarding supplements, the relevant clinical records of Patients E, F and G, and the statement supporting the necessity for multiple cervical supports for Patients E and F.
d. In response to a Subpoena Duces Tecum served on or about October 7, 2003, Dr. Holland failed to provide clinical and financial records for Patients L, S, Y, and BB and documentation related to the therapeutic effectiveness of various supplements. Further, the records for Patients I, AA, CC, DD, GG, and HH lacked either clinical records or financial statements for services rendered and payments received.
e. In response to a Subpoena Duces Tecum served on or about February 2005, Dr. Holland failed to provide the contract or agreement between her or her clinic and Anthem Blue Cross/Blue Shield.
I, Mary Darlene Holland, D.C., by affixing my signature hereto, acknowledge that:
1. I have been advised specifically to seek the advice of counsel prior to signing this document and am represented by C. Jacob Ladenheim, Esquire;
2. I am fully aware that without my consent, no legal action can be taken against me, except pursuant to the Virginia Administrative Process Act, § 2.2-4000.A et seq. of the Code of Virginia;
3. I have the following rights, among others:
a. the right to a formal hearing before the Board;
b. the right to representation by counsel; and
c. the right to cross-examine witnesses against me.
4. I waive all rights to a formal hearing;
5. I neither admit nor deny the truth of the above Findings of Fact, and I agree not to contest these findings at any future proceedings before the Board;
6. I agree not to petition for reinstatement of my license for at least four (4) years from the effective date of this order, which shall be August 31, 2006. I agree that prior to any petition for reinstatement I will undergo a comprehensive, multi-day, multidisciplinary assessment by a Board-recognized facility and/ or evaluators associated with the facility that will state that I am safe to resume the practice of chiropractic in the Commonwealth of Virginia. The assessment by the Board-recognized facility shall take place no more than three (3) months prior to my submission of a petition for reinstatement. In addition to providing the evaluators with any documents I feel are relevant, I agree to provide the facility/ evaluators with the following documents:
a. a copy of this Consent Order;
b. a complete copy of the investigative reports, excluding medical and billing records for Patients A-Zand AA-TT, for Case Numbers 69724, 73831, 76019, 76090, 76118, 77196, 82192, 95382, and 101454.
I shall ensure that receipt of the aforementioned documents is acknowledged in the report( s) to the Board;
7. I agree to sign an authorization providing for unrestricted communication between and among the Board and my treating and/ or evaluating practitioners;
8. I understand that undergoing the comprehensive multi-day, multi-disciplinary assessment does not guarantee the approval of any petition for reinstatement that I may submit to the Board for consideration and does not in any way limit the Board's authority to place additional terms on my license upon reinstatement; and
9. I consent to the following Order affecting my license to practice chiropractic in the Commonwealth of Virginia.
WHEREFORE, based on the foregoing Findings of Fact and Conclusions of Law, and with the consent of the licensee, it is hereby ORDERED that the license of Mary Darlene Holland, D.C., be INDEFINITELY SUSPENDED, effective July 31, 2006. Further, effective June 26, 2006, Dr. Holland shall be prohibited from seeing or treating new patients in her chiropractic practice.
Dr. Holland shall not petition the Board for reinstatement of her license for a minimum of (4) four years from the effective date of this Consent Order. Should Dr. Holland seek reinstatement of her license, she shall be noticed to appear before the Board, in accordance with the Administrative Process Act. As petitioner, Dr. Holland has the burden of proving her competency and fitness to practice chiropractic in the Commonwealth of Virginia in a safe manner.
Pursuant to Section 54.1-2920 of the Code, upon the effective date of this Consent Order, Dr. Holland shall forthwith give notice, by certified mail, of the suspension of her license to practice chiropractic to all patients to whom she is currently providing services. A copy of this notice shall be provided to the Board when sent to patients. Dr. Holland shall cooperate with other practitioners to ensure continuation of treatment in conformity with the wishes of the patient. Dr. Holland shall also notify any health insurance companies, health insurance administrators or health maintenance organization currently reimbursing her for any of the healing arts. Further, within five (5) days of the effective date of this Consent Order, Dr. Holland shall return her current license to the Board office.
Effective July 31, 2006, the license of Mary Darlene Holland, D.C., will be recorded as SUSPENDED and no longer current.
Violation of this Consent Order shall constitute grounds for the revocation of the license of Dr. Holland. In the event Dr. Holland violates any of the terms and conditions of this Consent Order, a formal administrative hearing shall be convened to determine whether her license shall be revoked.
Consistent with the terms of this Consent Order, in the event that Dr. Holland seeks reinstatement of her license to practice chiropractic, she shall be responsible for any fees that may be required to petition for reinstatement or to renew her license prior to issuance of a license to resume practice.
Pursuant to Section 54.1-2400.2(F) of the Code, the signed original of this Consent Order shall remain in the custody of the Department of Health Professions as a public record and shall be made available for public inspection and copying upon request.
FOR THE BOARD:
William L. Harp, M.D.
Virginia Board of Medicine
SEEN AND AGREED TO:
Mary Darlene Holland, D.C.
This article was posted on February 25, 2016.