Benjamin Zimberoff Darrow, 48, a licensed Chiropractor from Daly City, California, pleaded not guilty to several federal charges on Monday, May 20, 2019. Charges include insurance fraud, the unlicensed practice of medicine, illegal laboratory markup, and the theft of over $100,000. He faces up to two years in prison.
Prosecutors claim Darrow engaged in illegal activity when he sold ALCAT allergy testing to his patients. ALCAT testing is not covered by insurance because the accuracy of the testing method is unverified. ALCAT testing uses flow cytometry to measure the percentage change in the distribution of cell sizes at baseline and after food challenges. The percentage of change in the control group was found to be less than 9% while a change greater than 13% results in a positive test. A change between 9-13% is considered equivocal. The results are used to customize an elimination or rotation diet to eliminate foods that supposedly trigger chronic immune system activation. Applied conditions for ALCAT testing include gastrointestinal complaints, skin diseases, neurological and mental disorders, respiratory disease, metabolic diseases, endocrine disorders, musculoskeletal and joint disorders, immune system, and other comorbidities.
While the Coulter counter used in testing is validated to measure white blood cell volume accurately, the science behind the application of these findings is unclear. A critical published review of the ALCAT test concluded there is not enough data to determine the clinical parameters of clinical sensitivity, clinical specificity, or predictive values. A recent study agreed, reporting that the ALCAT test lacks scientific and clinical proof of efficacy.
Prosecutors claim Darrow used inappropriate procedure codes to charge for the excluded ALCAT test (insurance fraud). Darrow claimed testing occurred in his office, but he was sending blood samples to an outside lab that charged $600 to run the test while he charged $3000 to the insurance companies (illegal laboratory markup). The illegal billing practices included 250 patients and $790,000 in fraudulent insurance reimbursements (theft of over $100,000). According to the State of California Board of Chiropractic Examiners, “a duly licensed chiropractor may treat any condition, disease, or injury in any patient, including a pregnant woman, and may diagnose, so long as such treatment or diagnosis is done in a manner consistent with chiropractic methods and techniques and so long as such methods and treatment do not constitute the practice of medicine by exceeding the legal scope of chiropractic practice” (unlicensed practice of medicine).
It appears the State of California will not tolerate Chiropractors (or likely doctors, NPs or PAs) who offer allegedly unvalidated laboratory testing to diagnose and treat medical conditions- with or without a medical license. Nor should they. With healthcare fraud expected to reach $2,242,700,000 by 2022, a significant increase from $504,400,000 in 2016, anyone providing direct medical care should be wary of slick marketing strategies used by companies offering unsubstantiated testing and diagnostic tools. These businesses exist to line the pockets of ancillary service providers whose sole purpose is to separate consumers from their money, rather than provide value in population health.