Chiropractors getting hundreds of millions in improper Medicare payments

Medicare still hasn't implemented needed controls to prevent fraud, waste and abuse related to chiropractic services, a government watchdog is reporting.

Frustrated federal watchdog calls for action.

Make off with millions by going small and flying under the government radar. That seems to be the takeaway in a new report by a government watchdog.

Every year, Medicare is shelling out hundreds of millions of dollars for massages, acupuncture and other ineligible or medically unnecessary services that are billed by chiropractors, says the report, by the inspector general of the federal health department.

Medicare patients are out millions, too, for coinsurance payments to chiropractors for medically unnecessary services, according to the report.

Yet despite years of warnings about the problem, the agency responsible for overseeing Medicare – the Centers for Medicare and Medicaid Services -- hasn't made it a priority to identify and stop the waste, fraud and abuse, says the report.

One reason: Payments for individual chiropractic services are small, ranging from $29 to $54 dollars, the report says. But, the OIG notes, Medicare is paying more than $450 million a year for the services.

CMS has made some recommended fixes, but they either were ineffective or chiropractors quickly found ways around them, according to the watchdog report, which reviews prior findings of Medicare vulnerabilities.

The agency also tried educating chiropractors on Medicare billing requirements. But, the report says, chiropractors in at least one jurisdiction “were resistant to education and not willing to change their billing patterns.”

Among the abuses cited in the report, taxpayer money has gone to chiropractors who report extraordinary work – such as one in Illinois who was paid for an average of 88 services a day. Some chiropractors also submitted claims for services that were never provided.

But the majority of improper payments were for services that Medicare deems medically unnecessary, such as massages. Medicare could save millions, the inspector general says, by requiring medical reviews for claims involving patients who exceed some threshold number of chiropractic services in a year. Medicare has such thresholds for other types of services, it notes.

CMS also could protect the Medicare Trust Fund, the report says, by implementing other recommendations the OIG has made over the years. And CMS should analyze its own payment data to identify chiropractors with suspicious or aberrant billing patterns, the OIG says.

Medicare covers chiropractic services for active/corrective treatment when spinal bones are misaligned. But it doesn’t cover maintenance therapy that is supposed to prevent disease, promote health or enhance quality of life.

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