OIG Says 47% of Chiropractic
Medicare Claims Inappropriate
The
US Department of Health, Office of the Inspector General
(OIG) issued a report that states, "Medicare
inappropriately paid $178 million for chiropractic
claims in 2006, representing 47 percent of claims
meeting our study criteria." The Report which can
be read
here,
is dated May 2009 from Daniel R. Levinson, Inspector
General.
The objective of the report
was stated as;
To
determine the extent to which:
(1) chiropractic claims allowed in 2006 for
beneficiaries receiving more
than 12 services from the same chiropractor were
appropriate,
(2) controls ensured that chiropractic claims were not
for maintenance therapy,
(3) claims data can be used to identify maintenance
therapy, and
(4) chiropractic claims were documented as required.
This report conveniently
comes out in the heat of the national healthcare debate
in Washington. The study was done by the OIG contracting
with a medical review contractor to review medical
records from a simple random sample of 188 chiropractic
claims.
Based upon this single
reviewer's opinion, sampling only 188 claims, the OIG
issued the report which includes the following, "In
2006, Medicare inappropriately paid $178 million (out of
$466 million) for chiropractic claims for services that
medical reviewers determined to be maintenance therapy
($157 million), miscoded ($11 million), or undocumented
($46 million). These claims represent 47 percent of all
allowed chiropractic claims that met the study criteria.
Claims representing $36 million had multiple errors."
As if this was not bad
enough, the OIG also said, "Efforts to stop payments for
maintenance therapy have been largely ineffective." And
they continue, "...83 percent of chiropractic claims
failed to meet one or more of the documentation
requirements."
The question begs to be
asked, are 83% of all chiropractors doing it wrong, or
is the process so medically broken that only 17% of DCs
can comply with a totally non-chiropractic system. Some
day someone will figure out that THERE IS NO MEDICAL
NECESSITY FOR CHIROPRACTIC. Can you imagine a system
where the appropriateness of medical care was judged
using the criteria of "Chiropractic Necessity"?
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