The government isn't doing enough to prevent improper chiropractic payments, particularly claims involving "maintenance therapy," according to a new report released by the Office of Inspector General (OIG).
A review of chiropractic claims in 2013 found that the Centers for Medicare & Medicaid Services (CMS) paid $76 million for chiropractic services that were identified as questionable. Nearly half of those payments were for claims indicative of maintenance therapy. Medicare only covers chiropractic services categorized as "active treatment" designed to improve function.
Previous reports have shown the improper payment rate for chiropractic services is the highest among all Part B services, and it's increased steadily over the last several years, jumping from 43.9 percent in 2010 to 54.1 percent in 2014.
Based on previous fraud reports and investigations, the OIG targeted four areas within chiropractic claims: treatment suggestive of maintenance therapy, potentially upcoded claims, sharing beneficiaries with other chiropractors and an unlikely number of services provided per day.
Nearly 16 percent of chiropractors submitted questionable claims, according to the OIG. Most frequently, those claims involved treatment suggestive of maintenance therapy or sharing beneficiaries.
Furthermore, just 2 percent of all chiropractors that billed Medicare were responsible for $38 million in questionable payments. A majority of those chiropractors also practiced in high fraud areas of the country, including California, Michigan, Illinois, Kansas, New York, New Jersey and Florida.
The OIG outlined five recommendations for CMS, calling for the agency to:
- establish more reliable controls to differentiate active treatment from maintenance therapy.
- develop measures to identify questionable payments tied to chiropractic services.
- take appropriate action on providers with questionable payments.
- collect overpayments.
- ensure claims are paid for Medicare-covered diagnoses.
CMS agreed with all but the first recommendation, citing "significant obstacles" and arguing that new medical review requirements would combat fraudulent payments tied to maintenance therapy.
FierceHealthPayer: Antifraud has previously reported on some of the major fraud schemes prevalent within the chiropractic industry, including upcoding, and misuse or overuse of services. A string of chiropractic fraud cases surfaced earlier this year and late last year involving services that were never provided. In June, a New Jersey chiropractor was accused of taking kickbacks to refer patients to Diagnostic Imaging Affiliates.
Here's the OIG report