According to the Inspector General of the U.S. Department of Health and Human Services, Medicare paid out in 2012 and 2013 approximately $1.4 billion for chiropractic services. Based on prior 2006 audit, the government decided to revisit chiropractic care to see if these services were being properly billed.
The 2006 review estimated that about 38% of chiropractic services paid for Medicare were improper. That means for every $10 in tax money paid to chiropractors, almost half of that money was waste or fraud.
Did things improve over the last 10 years? They got worse! A random audit in August 2016 by the Inspector General of a Michigan chiropractic clinic found that 92% of their services were improperly billed! In one case, a 72-year-old man had 167 office visits in a short period of time and with no improvement. Medicare rules say that you can’t keep doing the same thing over and over if the is the patient isn’t responding to treatment.
This audit follows another recent random audit in Arizona with similar results.
Medicare Part B covers, among other services, chiropractic services provided by a qualified chiropractor. Medicare requires that these services be reasonable and necessary for the treatment of a beneficiary’s illness or injury. While chiropractic care can be a safer and less costly alternative to surgery, chiropractors can’t fix everything and must show medical necessity. When that isn’t done, there is the potential for a False Claims Act whistleblower case.
People working in a chiropractor’s office with evidence that doctors are performing medically unnecessary treatments, intentionally overbilling, upcoding or even billing but not performing any services whatsoever may be entitled to a substantial award. If you have evidence of billing or other fraud involving Medicare or Medicaid, we may be able to help you stop the fraud and collect an award. Our contact information is found throughout this website.