Medicare Issued Hundreds of Millions in Improper Chiropractic Payments During FY 2010-2015

On Friday, the Office of Inspector General (OIG) revealed that between the fiscal years 2010-2015, roughly half of chiropractic Medicare payments went towards services that were medically unnecessary, not billed properly, or insufficiently documented.

During that time, the massive entitlement program spent $2.9 billion overall on chiropractic services, generally considered an alternative form of medicine, with between $257 million to $304 million per fiscal year going toward improper payments:

Screenshot/HHS OIG

Chiropractic services, according to OIG, were susceptible to fraud and experienced a higher percentage of improper payments than other Medicare Part B services.

The OIG report complained that the Centers for Medicare and Medicaid Services (CMS) only implemented some of their recommendations for preventing improper payments.

“Medicare could save millions of dollars by reducing payments for medically unnecessary services without compromising beneficiary access to reasonable and necessary services,” the report read.

CMS agreed to implement two of OIG’s new recommendations — focused on educating chiropractors on training materials, and beneficiaries on what Medicare actually covers — but disagreed with two other recommendations.

Those requested CMS to identify a threshold for necessary services, identify chiropractors with aberrant billing practices, and refund overpayments from Medicare.

With a threshold on services, OIG said, Medicare could have saved roughly between $95.1 million to $446 million in costs from calendar years 2013-2015.

During that same time, Medicare beneficiaries could have saved an estimated $24.3 million.

“We strongly encourage CMS and its contractors to take actions to implement our third and fourth recommendations,” the OIG said.

“Implementing these recommendations would … help Medicare reduce fraud, waste, and abuse related to chiropractic services,” the report continued.

Additionally, the report claims that the OIG fraud investigations resulted in about $7.6 million in settlements and restitution.

In a response, CMS said it shared the OIG’s concerns but cautioned that improper chiropractic payments were less than one percent of those for Medicare fee-for-service.

“CMS stated that it is committed to using its resources to most efficiently address fraud, waste, and abuse and considers multiple factors, including potential savings, when targeting program integrity resources for specific services,” the report read.