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Editor's note: A previous version of this article has been corrected to accurately reflect Dan Bowerman's job title. He is a practicing chiropractor.
Chiropractors may be the newest group facing federal scrutiny following a new report that indicates the majority of claims submitted to Medicare were linked to unnecessary services.
Approximately 82 percent of chiropractic claims submitted to Medicare in 2013 were medically unnecessary, leading to nearly $359 million in overpayments, according to a report released by the Office of the Inspector General (OIG). Although a large portion of sampled claims within the first dozen provider visits were found to be medically unnecessary, virtually every claim for subsequent treatments was medically unnecessary, including all claims beyond the 30th visit.
Auditors focused specifically on the “active/corrective treatment” modifier, which Medicare requires chiropractors to include in order to receive reimbursement. However, the accompanying documentation suggests that many claims actually qualified as maintenance therapy.
The OIG recommended that the Centers for Medicare & Medicaid Services institute a maximum number of annual chiropractic visits eligible for reimbursement. In a letter responding to the report, CMS Acting Administrator Andrew Slavitt rejected the notion of limits, arguing the agency was “not aware of medical evidence that would support such a determination.”
The OIG also advocated for more reliable controls to better identify maintenance therapy, an issue it criticized in a report released last year that identified $76 million in questionable chiropractic claims. Chiropractor Dan Bowerman previously told FierceHealthPayer: Antifraud that the profession’s limited scope of practice and ability to bill for services creates the opportunity for improper billing.