"Dr." Arthur Copes Convicted of Insurance Fraud

Stephen Barrett, M.D.

In 2008, Arthur L. Copes, who owned and operated the Scoliosis Treatment Recovery System Clinic in Baton Rouge, Louisiana for many years, was found guilty of 8 counts of insurance fraud [1]. Copes purports to have developed a back brace and treatment system that he claims is effective against scoliosis. Experts who have looked at what he does do not believe that this is true. Copes has also misrepresented his credentials.

In 2006, Copes was charged with 117 counts of insurance fraud for his alleged involvement in a medical billing insurance scam and for practicing medicine without a license. Attorney General Special Agents who investigated his activities alleged:

The trial at which Copes was convicted involved only his billings to Blue Cross Blue Shield of Louisiana. In January 2009, he was sentenced to three years in prison to be followed by 15 years of supervised probation. He was also ordered to pay restitution of $88,000 to Blue Cross Blue Shield and a total of $100,000 to several former clients. During the sentencing hearing, the judge said to Copes:

I am deeply concerned that you have not taken responsibility or shown any remorse for your actions. I will not allow you to continue to present yourself as a doctor and possibly harm even one person because you are not trained and skilled in the areas in which you lead people to believe [3].

Copes appealed. In December 2009, after reviewing the trial testimony in detail, the Louisiana Court of Appeal upheld his conviction but ordered the trial judge to reconsider the sentence [4]. In February 2010, the trial judge reset the restitution total at $162,279, which included $47,000 to the Louisiana Department of Justice for investigation and prosecution costs and $4,600 to the National White Collar Crime Center [5].

Questionable Credentials

In 2006, Copes's Web site described him as an orthotist and stated that "for over 23 years he has researched scoliosis and is one of the foremost experts in the disease." [6] The biographical sketch on his Web site included the following items:

EDUCATION

Internship
Orthotic Medical Internship, Blodgett and Butterworth Hospital, Grand Rapids, MI, 1976-1977

Residency
Orthotic Residency Program, Mary Free Bed Hospital and Rehabilitation Center, Grand Rapids, MI, 1977-1978

Medical School
Columbia Pacific University
Department of Health and Human Services
San Rafael, California
Doctorate of Philosophy (Ph.D.), Orthotics, 1988-1989

College(s)
Columbia Pacific University
Mill Valley, California
Bachelor of Science (Orthotic Devices), 1976-1984

Delgado Community College/Tulane
New Orleans, Louisiana
Associate Degree, Orthotics and Prosthetics, 1975-1977

Although these items suggested that Copes had extensive medical training, I do not believe that he did. Columbia Pacific University was not a medical school. In fact, it was a correspondence school that was never accredited and in 1999 was ordered to permanently shut down by a California court [7]. His biographical sketch listed 14 publications, none of which were in medical or scientific journals. Stedman's Medical Dictionary defines orthotics as "the science concerned with the making and fitting of orthopedic appliances" and orthotist as "a maker and fitter of orthopedic appliances." Copes has two patents for ankle support devices, but he was not successful in patenting the brace that is the centerpiece of his scoliosis treatment system [8]. An earlier version of his curriculum vitae contained the entry "1976-1984 Northwestern Medical School" [9]. However, a school official has certified that no student named Arthur Copes ever attended that institution [10].

Toward the end of his practice, Copes's Web site contained a notice that the Louisiana State Board of Medical Examiners requires him to make available a statement which disclosed that (a) he was not a medical doctor, (b) orthotists are not licensed in Louisiana, (c) it is not permissible for an orthotist to attempt to diagnose any medical condition or ailment, and that unreferred patients must be seen by a licensed medical doctor before undergoing specific orthotic treatment [11].

Questionable Claims

Copes claims that scoliosis impairs the neurological, hormonal, and nutritional systems and "affects the body down to the cellular level." [12] His "Scoliosis Treatment Advanced Recovery System" (STARS) —also referred to as Scoliosis Treatment Recovery System" (STRS)—includes: "scoliosis muscle stimulation therapy," chiropractic spinal manipulation, "ocular/vestibular therapy," "nutritional/hormonal support," the Copes Lateral Fulcrum Board, and the Copes Dynamic Brace. His Web site has claimed:

The Scoliosis Treatment Advanced Recovery System is designed to reverse idiopathic scoliosis. Unlike other treatment plans, STARS addresses the full spectrum of symptoms including bone deformities, muscle imbalance, neurological changes, cellular nutrition and cellular hormonal deficits. . . .

With STARS, success comes without the need for painful and sometimes dangerous surgery. . . .

STARS . . . . not only arrests spinal curvature progression, it straightens it.... much like orthodontic braces straighten teeth. Spinal curvatures are reversed while every system in the body is re-educated to hold the straightened spine. . . .

Through years of clinical research, component development and continuous improvement, the STARS methodology has helped patients of all ages and degrees of severity. It is the exclusive scoliosis treatment protocol of Physicians from all around the world. . . .

When patients choose the STARS they enter into the most advanced scoliosis treatment program in the world. With adequate time and dedication, and compliance with all aspects of the STARS program, a patient can be certain they are on the road to non-surgical recovery from scoliosis [13].

Copes advised chiropractors who refer to him to have their patients undergo hair analysis to determine what dietary supplements they need [14]. Hair analysis is not valid for this purpose [15]. Moreover, nutrition is not a factor in the development or treatment of scoliosis. The electrical treatments Copes recommends are also unwarranted. Scientific studies have concluded that bracing is far more effective than electrical treatments [16].

There is no evidence that chiropractic treatment can reduce or prevent scoliotic curvature. In 2001, for example, researchers at two chiropractic colleges reported that chiropractic intervention had no discernible effect on the scoliotic curves of children ages 6 to 12. The study involved 42 children who were treated for a year with full-spine manipulation. Some were also treated with heel lifts, postural counseling, and/or lifestyle counseling. The scoliotic curves ranged from 6 to 20 degrees. The authors stated that although case reports abound, this was the first published clinical trial of the effect of chiropractic treatment on adolescent scoliosis [17].

Aetna has classified the Copes brace as investigational, which means that its insurance policies do not cover its use. Its clinical policy bulletin states:

The Copes Scoliosis Brace is a custom-fitted polypropene support structure that utilizes air to attain spinal curvature correction. This is achieved through the use of strategically placed pneumatic force vector pads that are adjusted every 4 to 6 weeks during treatment. The brace is generally used for 12 to 36 months in conjunction with hydrotherapy, regular muscle strengthening exercises, as well as chiropractic treatments such as osseous manipulation and muscle stimulation therapy. There is no scientific evidence that the Copes Scoliosis Brace is effective in treating scoliosis. Additionally, there are no published data concerning the long-term effectiveness of this device, the rate of recurrence of scoliosis after patients stop wearing the brace or the number of patients who eventually have to undergo surgical intervention. Furthermore, the Copes Scoliosis Brace is used in conjunction with hydrotherapy, regular muscle strengthening exercises, and chiropractic treatments. Thus, it is unclear what role the brace actually plays in the improvement, if any, of the condition [18].

Copes was one of the four initial trustees of the Scoliosis Care Foundation, which was founded by Gary A. Deutschman, D.C., who practices in New York City. After working with Copes for several years, Deutschman developed his SpineCor program that he has said "offers corrective and palliative therapy for all degrees of spinal curvature." [19] One preliminary study has reported benefit [20], but Aetna has concluded:

There is a lack of scientific evidence in the peer-reviewed published medical literature to support the effectiveness of the SpineCor Scoliosis System in treating idiopathic scoliosis, including insufficient data on its long-term effectiveness and a lack of studies directly comparing the dynamic corrective brace with rigid bracing systems [18].

Questionable Cost

In 1999, Mark S. Rosenthal, M.D., an assistant professor of orthopedic surgery at the University of Maryland School of Medicine in Baltimore, Maryland, investigated Copes and provided me with the following comments:

Copes's approach appears to be far more costly than standard treatment. The brace costs $3,750, not including the initial casting, orthotic training, and x-ray evaluations, and follow-up office visits to his office in either Baton Rouge, Louisiana or San Diego, California.

A standard brace costs about $1,250. A growing child typically outgrows braces, and at least two will be needed (cost for two = $2,500). Copes's recommended treatment includes chiropractic manipulations three times a week for a year and then less frequently. Assuming $30 per visit, one years’ worth would cost $4,680. The second year, assuming half the visits, would be $2,340. Thus the two-year cost would be at least $14,520 for just the brace and chiropractic. Other costs include nutritional therapy, ocular vestibular therapy, exercises, and electrical muscle stimulation. The average cost for a scoliosis fusion, including the hospitalization, surgeon’s fee, follow-up visits, x-ray films and physical therapy is about $30,000, most of which is likely to be eligible for insurance coverage. insurance. While this is twice the amount listed above, the amount above is only for half the treatment. The Copes treatment is intended to be lifelong. Standard surgery is a one-time event. Surgery is indeed painful, but only for about ten days (the first two or three days are the worst, after that the pain is milder). Wearing a brace is uncomfortable, and the Copes brace is for a lifetime.

Bankruptcy and Lawsuits

In 2003, despite claiming to have treated than 4,000 patients, Copes filed for bankruptcy protection claiming to have assets of $50,000 or less and debts of more than $1 million. His local newspaper reported that his 20 largest creditors included the Internal Revenue Service ($173,273) and the Louisiana Department of Revenue ($11,464). The report also noted that three former patients had filed suit against him during the previous three years [21].

The Bottom Line

The Copes Scoliosis Treatment Recovery System offers no advantage over standard methods and is generally far more costly and burdensome. Copes offers no scientific evidence that it is effective. The Copes brace appears to be the same or similar to standard braces, which is probably why it did not receive a patent. Standard braces offer the same results at lower cost. The Copes system also includes other therapies that have no proven value.

Orthopedic surgeons routinely treat patients with braces with excellent results and recommend surgery only if conventional brace treatment fails [22]. The Copes system is far more costly for patients who do not require surgery and—in the long run—would cost even more and involve more discomfort for those who do.

References

  1. Arthur Copes found guilty of insurance fraud. Press release, Louisiana Attorney General, July 29, 2008.
  2. Owner of Scoliosis Treatment Recovery System in Baton Rouge surrenders to Attorney General Special Agents. Louisiana Attorney General news release, Feb 23, 2006.
  3. Copes taken out of courtroom in handcuffs. Luoisiana Attorney General Web site, Jan 28, 2009.
  4. Judgment. Louisiana Court of Appeal, First Circuit. Case No. 2009 KA 1206, Dec 23, 2009.
  5. Gyan J. Man to pay restitution for fraud. The Advocate, Feb 18, 2010.
  6. Founder - Arthur Copes, Ph.D. Scoliosis.com, accessed Feb 26, 2006.
  7. Barrett S. Court orders Columbia Pacific University to cease operating illegally in California. Quackwatch, revised, Feb 26, 2006.
  8. In 1999, Copes's Web site stated that in 1987 he had applied for a patent for the "Copes Thoracic Lumbar Sacroiliac Orthosis" However, a search of the U.S. Patent Office database on Feb 26, 2006 for "Copes" (as inventor) found that the application was not granted.
  9. Arthur L. Copes, Ph.D., orthotist. Scoliosis.com Web site, archived in 1999.
  10. Letter to Katie Thomas from Jack F. Snarr, Ph.D., Associate Dean for Student Programs, Northwestern Medical School, Jan 19, 1998.
  11. Disclosure statement. Scoliosis.com, accessed Feb 26, 2006.
  12. Scoliosis overview. Scoliosis.com, accessed Feb 26, 2006.
  13. STARS treatment. Scoliosis.com, accessed Feb 26, 2006.
  14. Copes AL. STRS: Scoliosis Treatment Recovery System: Phase II Manual. Copes Scoliosis Foundation, 1998.
  15. Barrett S. Commercial hair analysis: A cardinal sign of quackery. Quackwatch, Jan 5, 2001.
  16. Rowe DE and others. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. Journal of Bone and Joint Surgery 79:664-674, 1997.
  17. Lantz CA, Chen J. Effect of chiropractic intervention on small scoliotic curves in younger subjects: A time-series cohort design. Journal of Manipulative and Physiological Therapeutics 24:385-393, 2001.
  18. Idiopathic scoliosis treatments. Aetna Clinical Policy Bulletin 0398, reviewed July 24, 2009.
  19. Scoliosis Systems home page, accessed July 13, 2006.
  20. Roberts PB. Judge probes BR man's medical credentials. The Advocate (Baton Rouge, Louisiana), Aug 30, 2003.
  21. Couillard C and others. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the Scoliosis Research Society for adolescent idiopathic scoliosis. Journal of Pediatric Orthopedics 27:375-379, 2007.
  22. Rosenthal MS. Scoliosis: A sensible approach. Quackwatch, Feb 7, 1998.

This article was revised on February 18, 2010.

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