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Whistleblowers are Natural Allies in HHS OIG’s Effort to Crackdown on Improper Payments to Chiropractors

Posted  October 20, 2016

By the C|C Whistleblower Lawyer Team

According to a new report by the Department of Health and Human Services’ Office of Inspector General (OIG), more than 80% of all Medicare payments for chiropractic services in 2013 went towards medically unnecessary procedures. As a result, the government spent nearly $359 million on unnecessary care. Although Medicare covers chiropractic services for active and corrective treatment of spinal subluxation, it does cover not “maintenance therapy,” where no further clinical improvement can reasonably be expected. To conduct the report, OIG randomly sampled 105 claims for chiropractic services. Of these, it concluded that 93 were for maintenance therapy, treatments inappropriate for the patient’s condition, or both.

And this is not the first time that OIG exposed questionable billing practices by chiropractors. An earlier OIG report found $285 million in improper payments for chiropractic services in 2001, 67% of all Medicare payments to chiropractors that year. In addition, four recent OIG reviews of individual chiropractors revealed payments for medically unnecessary or undocumented services.

So how do we address this waste of taxpayer dollars? The new report calls on the Centers for Medicare and Medicaid Services (CMS) to implement “strong controls” to prevent improper payments, such as determining the number of services reasonably necessary to actively treat spinal subluxation and reviewing claims in excess of that number.

But there’s another way to fix this industry. The False Claims Act is a federal law that allows private citizens with knowledge of fraud against the government to sue fraudsters on the government’s behalf. To encourage such individuals to come forward with good information, the law allows whistleblowers to keep 15–30% of the government’s recovery as a reward. Chiropractors and employees of chiropractic offices with first-hand knowledge of questionable billing practices occupy a unique position. As whistleblowers, they can serve as the eyes and ears of the Government and serve as a first line of defense in the Government’s efforts to combat Medicare fraud.

The False Claims Act is the federal government’s most effective and successful tool in combating waste, fraud, and abuse. Between 2009 and late 2015, the federal government recovered more than $26 billion under the False Claims Act, of which nearly $16.5 billion related to Medicare and other governmental healthcare programs.

Tagged in: Healthcare Fraud,