- The vast majority of Medicare payments for chiropractic services in 2013 – about 82% – failed to comply with Medicare requirements, according to a new study of sample data reported by HHS' Office of Inspector General.
- Based on those samples, the OIG estimated $358.8 million of the $438.1 million that Medicare paid for chiropractic services that year was officially unallowable.
- The report argued the overpayments have occurred because CMS' controls are ineffective, and that unless CMS addresses its lack of controls, it will most likely to continue to allow improper payments for chiropractic services.
The crackdown on over-billing for chiropractic services comes as part of the federal government's sweeping overall attack on fraudulent billing of government health programs, which serves as part of the effort under the ACA to reduce healthcare spending – particularly as real healthcare costs continue to rise and population aging comes into increasing play.
In regard to chiropractic services, Medicare coverage is limited to manual manipulation of the spine to correct a spinal subluxation, and only for corrective treatment, not maintenance therapy. However, the OIG found even when claims included the acute treatment modifier, that did "not always indicate that the service provided was reasonable and necessary."
OIG recommended CMS implement controls for identifying maintenance therapy, but that CMS disagreed with the recommendation, arguing there were obstacles to developing such a control.
The recommendations included determining a reasonable number of services for treating spinal subluxation, a process for reviewing claims that exceed that number, a limit for the number that Medicare will reimburse, and a process to enforce that limit. The OIG also recommended further chiropractor education on the limits of Medicare coverage proper use of the acute treatment modifier.
Part of CMS' disagreement, the OIG report noted, was the agency said it was unaware of medical evidence to support a determination for how many chiropractic services Medicare should reimburse.