OIG Report: chiropractor fraud costing Medicare of hundreds of millions of dollars per year

 

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A report just issued by the U.S. Department of Health and Human Services Office of Inspector General reveals that the Government overpaid chiropractors for their services an average of $257 million to $304 million per year over a 6 year period.  During this period Medicare paid a total of $2.9 BILLION for chiropractic services.  The improper payments were made for services that were medically unnecessary or not sufficiently documented.   Hundreds of millions of dollars in taxpayer moneys were paid to chiropractors for services that did not meet Medicare requirements.

The OIG concluded that chiropractic fraud is a major concern. One of the problems is the way payments are made, according to the report. Most Medicare claims are processed and paid without a review of the underlying medical records to support the claim.

Scrutiny of chiropractors invoicing of Medicare will increase now. In addition, fraud investigations have resulted in criminal cases where the chiropractic claims were submitted where services that were never performed and where the services were performed without a valid chiropractic license. In addition, criminal cases were brought where patient records were falsified or where chiropractic services were billed where they are not covered by Medicare, as with massage or acupuncture. These investigations resulted in 11 chiropractors being incarcerated and $7.6 million in restitution.

Chiropractic is a form of alternative medicine which focuses on the diagnosis and treatment of disorders of the musculoskeletal system, especially the spine. The more common form treatment is spinal manipulation. The purpose of this procedure is to restore joint mobility. Medicare covers chiropractic services for active/corrective treatment. Medicare does not cover chiropractic maintenance therapy as it prohibits payment for items that are not reasonable and necessary for the diagnosis or treatment of illness or injury to improve functioning.

Jeffrey Newman represents whistleblowers