An astounding 82 percent of Medicare payments for chiropractic services totaling hundreds of millions of dollars did not comply with Medicare rules and requirements, according to a new report from the Department of Health and Human Services Office of Inspector General.
The report released last week found that lax oversight by Medicare auditors in ferreting out improper payments for chiropractic services during 2013 resulted in a loss to the government of $358.8 million of the $439 million in total payments, according to the IG’s report.
The report was highly critical of the Centers for Medicare and Medicaid Services (CMS) and warned that “Unless the CMS implements strong controls, it is likely to continue to make improper payments to chiropractors.” In other words, the government likely continues to be bilked for hundreds of millions more for unnecessary chiropractic services.
Chiropractors are not medical doctors but health care professionals who diagnose and treat neuromuscular disorders and provide treatment through manual adjustment or manipulation of the spine when spinal bones are misaligned. Medicare Part B covers chiropractic services provided by a qualified chiropractor but requires the services be “reasonable and necessary” in treating a patient’s illness or injury.
Although Medicare imposes no specific limitation on the number of therapy sessions, CMS guidelines state that “acute conditions” may require as many as three months of treatment, while chronic back conditions may require an even longer period of treatment. The guidelines also say that when further clinical improvement “cannot be reasonably expected from continuous ongoing care,” the treatment is then considered “maintenance therapy” and no longer covered by Medicare.
In 2005, an OIG evaluation concluded that as chiropractic care went beyond 12 treatments in a year, “it became increasingly likely that individual services were medically unnecessary” -- and even more likely that services were medically unnecessary after 24 treatments. Chiropractors are required to indicate in their billings whether they provide “acute treatment” for a beneficiary or simply maintenance therapy which is not covered.
However, the inspector general’s report stressed that inclusion of the AT designation in a billing “does not always indicate that the service provided was reasonable and necessary.”
In conducting its investigation, the Inspector General’s office reviewed chiropractic services for 2013 for which a total of $438.1 million was paid out in reimbursements. The investigators found that 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,” the report stated. “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 each in unallowable Medicare payments, according to the report.
While there apparently is no way to recover the improper payments, the IG’s report recommended that CMS determine whether there should be a limit for the number of chiropractic services that Medicare will reimburse and, if so, should take appropriate action to put that limit into effect.