June 2005

OIG says 67% of DC services did
not meet Medicare criteria

A report by the Office of Inspector General (OIG) states that taxpayers were overbilled for chiropractic services in 2001 and that the Centers for Medicare and Medicaid (CMS) should eliminate the problem with “frequency-based controls.”

The report caught the interest of the national media, including the Associated Press, whose story has appeared in newspapers such as the Washington Post as well as online. The AP story said, “In one year, the government paid chiropractors for nearly $285 million in services that should not have been billed to Medicare” appeared in newspapers, including the and online.

The OIG report stated that approximately 67 percent of the chiropractic services allowed by Medicare in 2001 did not meet Medicare coverage criteria, were miscoded, or were undocumented, and resulted in $285 million in improper payments.

The American Chiropractic Association immediately challenged the report and issued a preliminary statement emphasizing that the report was based on data from 2001 — not current data. Since that time, said ACA, it has taken steps to reduce chiropractic error rates. One of those steps has been the release of a comprehensive documentation manual, as well as increased education of its members.

The June 2005 OIG report, entitled “Chiropractic Services in the Medicare Program: Payment Vulnerability Analysis,” identifies maintenance services as the most common type of non-covered chiropractic services that Medicare paid for in 2001. Medicare carriers routinely deny all chiropractic claims that do not carry a code for spinal manipulation, which is, by law, the only treatment for which chiropractors may be reimbursed.

OIG medical reviewers found that although billed with an allowable code, 57 percent of these services did not meet Medicare coverage criteria (i.e., were non-covered). In addition, 16 percent were miscoded or billed at the wrong level of spinal manipulation, and 6 percent were undocumented. Twelve percent had multiple errors, yielding an overall error rate of 67 percent.

Previous OIG studies, published in 1986, 1998, and 1999, also concluded that a significant vulnerability existed in connection with chiropractic services, particularly concerning maintenance care.

The OIG report made a number of recommendations to CMS to eliminate the overbilling problem, including using “frequency-based controls.”

The mission of the OIG is to protect the integrity of the Department of Health and Human Services (HHS) programs, and the health and welfare of its beneficiaries, through a nationwide network of audits, investigations, and inspections. OIG’s objective in this analysis was “to determine the underlying causes of, and potential ways to reduce, vulnerabilities associated with Medicare payments for chiropractic services.”

The 2005 analysis is available online at www.oig.hhs.gov/.

Sources: Office of Inspector General, www.oig.hhs.gov, the Washington Post, www.washingtonpost.com, American Chiropractic Association, www.acatoday.com.

Industry News from:
Chiropractic News from: