Chiropractors Face Major Changes in Medicare Billing and Reimbursement Rules
An audit of chiropractic services billed to Medicare has concluded that more than 80% of the claims for reimbursement should not have been approved or paid. The audit was conducted by the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services.
Based on a sampling of Medicare claims, OIG estimated that $358.8 million of the $438.1 million paid by Medicare for chiropractic services should not have been paid. In other words, OIG concluded that 82% of Medicare claims for chiropractic services were not valid. According to OIG, the overpayments occurred primarily because chiropractors billed for a high number of medically unnecessary services.
OIG recommended that the Centers for Medicare and Medicaid Services (CMS) institute strong controls to prevent improper payments for chiropractic services in the future. Among the suggested controls is a limit on the number of chiropractic services that Medicare will reimburse (such as no more than 30 per beneficiary per year), and a system that would automatically disallow services in excess of that limit.
The high percentage of overpayments means that the government will be looking very carefully at Medicare claims for chiropractic services from now on. The government will also be very interested in whistleblowers who come forward with evidence of excessive or medically unnecessary chiropractic services billed to Medicare.
Under the False Claims Act, individuals who come forward with evidence of false claims submitted to Medicare or Medicaid are entitled to substantial financial rewards and legal protections. The whistleblower rewards range from 15% to 30% of the amount the government recovers from the healthcare provider. Whistleblower rewards can reach hundreds of thousands of dollars and sometimes millions of dollars.
To qualify as a whistleblower you must comply with very strict procedural and confidentiality requirements. One misstep and you could lose your eligibility for a reward and legal protections. If you have evidence of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately, before your contact the government, to protect your rights.
You can schedule a free and confidential consultation with an experienced whistleblower lawyer by calling John Howley Esq. at 212-601-2728.