“Most Medicare payments for chiropractic services did not comply with Medicare requirements. Of the 105 sampled chiropractic services, 11 were allowable in accordance with requirements. However, the remaining 94 services were not allowable because they were medically unnecessary. As a result, the chiropractors who billed for these services received $2,447 in unallowable Medicare payments.”
On the basis of their sample results, the OIG “. . . estimated that $358.8 million, or approximately 82 percent, of the $438.1 million paid by Medicare for chiropractic services was unallowable” and stated: "We recommend that CMS do the following, which could have saved Medicare an estimated $358.8 million for CY 2013:
- Determine a reasonable number of chiropractic services that are necessary to actively treat spinal subluxation and implement a system edit to identify services for review in excess of that number.
- Determine whether there should be a limit for the number of chiropractic services that Medicare will reimburse; if so, take appropriate action to put that limit into effect, and implement a system edit to disallow services in excess of that limit.
- Improve education of chiropractors on Medicare coverage requirements for chiropractic services and the proper use of the AT modifier to ensure that only medically necessary chiropractic services are billed to Medicare.
- Specifically identify significant obstacles to developing a more reliable control for identifying maintenance therapy and work to establish such a control. (For example, CMS could determine a reasonable length for a chiropractic treatment episode and implement a system edit to identify services for review when the number of days between the date of initial treatment and the date of service exceeds that length.)
This most recent OIG report is nothing new. For example, the Office of the Inspector General of the Department of Health and Human Services released a report in May 2009 entitled: Inappropriate Medicare Payments for Chiropractic Services.
At the time, the Foundation for Vertebral Subluxation submitted a Freedom of Information Act Request and Matthew McCoy DC, MPH Vice President of the Foundation did a complete review of the 2009 OIG Report concluding:
“There are several concerns with this report from the OIG that include methodology, bias, and most distressing – perhaps a complete lack of understanding regarding the nature of the management of vertebral subluxation. The bold assumption is made by the drafters of this OIG report that fault lay at the feet of chiropractors however, the alternate suggestion is that perhaps the policies and procedures of the OIG, HHS, carrier staff and medical reviewers are ineffective, obtuse, contradictory and not based on sound science. The profession should call for an evaluation of the effectiveness of this program and its staff that takes into consideration this alternate view.”
In their response to the FOIA request the OIG refused to provide the crucial information requested by the Foundation. So much for an open government. Paid reviewers who may have a financial interest in the outcome of the OIG investigations are shielded from public view.
CLICK HERE to see related story from 2009
The Foundation has submitted a Freedom of Information Act (FOIA) request regarding this most recent 2016 OIG Report and will conduct a thorough review of all pertinent documents.
CLICK HERE to review the recently published 2009 Analysis by McCoy & the Foundation
In a series of policy recommendations the Foundation for Vertebral Subluxation recommends that chiropractors urge the federal government to allow the profession to fulfill Congress’ intent when it added subluxation correction to Medicare and reimburse them for the care necessary to correct and monitor subluxations.
CLICK HERE to view those documents
Instead of promoting this agenda the Chiropractic Cartel is instead working on an effort to expand the scope of practice in Medicare so that chiropractors can be reimbursed for all services allowed under their state scope.
CLICK HERE for Related Stories on Scope Expansion in Medicare
