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Summary of OIG Reports for Chiropractic

October 23rd, 2017 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Categories:   Chiropractic   Office of Inspector General (OIG)  
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The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services.  Here is a summary of the reports the OIG has released on chiropractic since 2005.  Click on the titles to access the complete reports at oig.hhs.gov.

2005: Chiropractic Services in the Medicare Program:  Payment Vulnerability Analysis

The report states that they found that:

They recommended that CMS:

2009: Inappropriate Payments for Chiropractic Services

The report states that they found that:

They recommended that CMS:

2013 Diep Chiropractic Wellness, Inc., Received Unallowable Medicare Payments for Chiropractic Services

In 2010 and 2011, Diep Chiropractic received Medicare Part B payments of $879,658 for
23,714 chiropractic services provided to Medicare beneficiaries.  The OIG reviewed a random sample of 100 chiropractic services.

The report states that they found that:

They recommended that Diep:

The report includes specific issues identified and Diep's response to the audit.  The findings were upheld.

2015 CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services

The report states that they found that: 

They recommended that CMS:

2015 Advanced Chiropractic Services Received Unallowable Medicare Payments for Chiropractic Services

IN 2011 and 2012, Advanced Chiropractic Services received Medicare Part B payments of $764,953 for 22,471 chiropractic services provided to Medicare beneficiaries. The OIG reviewed a sample of 105 chiropractic service line items.

The report states that they found that: 

They recommended that ACS:

The report includes specific issues identified and ACS's response to the audit.  The findings were upheld.

2015 Alleviate Wellness Center Received Unallowable Medicare Payments for Chiropractic Services

In 2012 and 2013, Alleviate Wellness Center received Medicare Part B payments of $498,764 for 16,343 chiropractic services provided to Medicare beneficiaries. The OIG reviewed a random sample of 100 chiropractic services.

The report states that they found that:

They recommend that the Center:

2016 Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply with Medicare Requirements

The OIG selected 105 services from 2013 and divided them into three groups of 35 services each, based on the number of services:

Medicare paid $2,712 for these 105 services and used the sample results to estimate the amount paid for chiropractic services that did not comply with Medicare requirements.

They found that:

They recommended that CMS:

2016 A Michigan Chiropractor Received Unallowable Medicare Payments for Chiropractic Services

In 2012 and 2013 a Michigan Chiropractor received Medicare Part B payments of $392,032 for 10,688 services provided to Medicare beneficiaries. The OIG reviewed a random sample of 100 chiropractic services.

The report states that they found that:

They recommend that the Michigan Chiropractor:

2017 A Brooklyn Chiropractor Received Unallowable Medicare Payments for Chiropractic Services

This OIG review covered 18,187 claims for which the Brooklyn Chiropractor received Medicare reimbursement totaling $875,987 for chiropractic services provided during 2011 and 2012. They reviewed a random sample of 100 claims. 

The report states that they found that:

They recommend that the Brooklyn Chiropractor:

The chiropractor's attorney used a consultant to dispute these findings, but they were upheld.

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