Future of Chiropractic
For over 100 years, chiropractic has proclaimed the way to health is through prevention and maintenance of the body through natural means. We have always had an uphill battle, fighting against medical and pharmaceutical foes. The tide has shifted with the prevention of illness and disease as a necessary method of extending our lifespan. The medical community has embraced prevention as if it has been theirs all along. In the meantime, chiropractic has come under heavy criticism. Some want to strip the term physician from our use and contain chiropractic. As Yogi Berra once said, “It’s déjà vu all over again!”
Since 2004, the government has been taking a closer look at chiropractic, due to the errors in documentation and coding. The Comprehensive Error Rate Testing (CERT) program revealed that chiropractic was number one in percent errors for claims submitted to Medicare. Despite aggressive education initiatives, chiropractic continues to be number one among the health care professionals for errors.
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Office of the Inspector General
In June 2005, the Office of the Inspector General (OIG) completed their study of chiropractic claims. In their report to Congress, the OIG stated that chiropractic had an astounding 67% of claims deemed to be fraudulent. Of those claims studied, 40% were for services that were determined to be for maintenance care.
Most recently, the OIG completed another study of chiropractic claims. In their May 2009 report, the OIG stated that of the claims studied, it found that 47% of the claims were for maintenance care, not coded properly or had insufficient documentation to justify the care provided. In 2008, the OIG proudly proclaimed that for every dollar they spent auditing healthcare, they recouped $17 for their investment.
It is estimated that it will take billions of dollars to fix the Medicare mess. Although President Obama continues to push his National Health Care Reform, we must keep in mind that the one sector of healthcare that the government has complete control over is Medicare. Health and Human Services (HHS) can regulate Medicare without the approving vote of Congress or the voter. When one is financially strapped, the easiest fix is to go after easy money. Unfortunately, in my opinion, the easy money is chiropractic. CERT reviews and the OIG reports have consistently pointed out chiropractic as the “low hanging fruit.”
More Auditors
Medicare has continued to hire more independent contractors as auditors of records. These auditors or “Regional Auditor Contractors” (RAC) largely work on commission. They can request documentation on records as far back as two years. Reportedly, many of the RAC is working on commissions as high as 24%. Once the files are examined, the provider must pay back money which is in turn used to fund other projects that will go after “bigger fish.”
Compliance Plans
In 2000, the OIG released its recommendations for completing a compliance plan for an institution. In the circumstance of a government audit with subsequent fines, a viable compliance plan will be used as a mitigating factor to avert or decrease fines and jail time.
Although compliance plans overseen by Certified Compliance Officers have been put in place in hospitals, medical doctors’ offices, nursing homes, Cancer Care Centers and other health facilities, it has been largely ignored by the chiropractic profession.
Compliance Plan Requirements
Certified Compliance Officers can effectively implement a compliance plan that will meet the OIG guidelines. To meet these guidelines, a compliance program must meet the following criteria:
- Implement Written Policies;
- Designate a compliance officer;
- Conduct comprehensive training and education;
- Develop accessible lines of communication;
- Conduct internal monitoring and auditing;
- Enforcing standards through well-publicized disciplinary guidelines; and
- Responding promptly to detected offenses and undertaking corrective actions.
To realize the importance of having a viable compliance plan, consider the following averages of recoupment from an audit. The repayment amounts are based on the average patients seen per week in the office and the amounts typically recouped in an audit.
Audit repayment averages:
- 70 patients per week, the average repayment amount is $40,000
- 200 patient visits per week, the average repayment amount is $160,000
- 350 patient visits per week, the average repayment amount is $800,000
In June 2009, in its “Semiannual Report to Congress,” the Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced expected recoveries of more than $2.4 billion for the first half of fiscal year (FY) 2009.
OIG’s expected recoveries for the period of October 2008 through March 2009 include $274.8 million in audit-related receivables and $2.2 billion in investigative-related receivables, which includes nearly $552 million in non-HHS receivables resulting from OIG work (e.g., the States’ share of Medicaid restitution).
“These recoveries reflect our dedicated efforts to reduce fraud, waste, and abuse in HHS programs,” said Inspector General Daniel R. Levinson. “We will continue to employ all of our audit, evaluation, investigation, and legal tools and also to collaborate with OIG’s government partners to accomplish this vital and expanding mission.”
On the Radar
You can quickly see that chiropractic is indeed on the government’s radar. In an era of bailouts and stimulus packages, we must understand that someone will ultimately pay for these benefits. Of course, taxes are expected to rise, but there is a limit to the amount of taxation that will be tolerated by the people. Other methods of funding will have to be found. Chiropractic will undoubtedly be used to partially fund the Medicare coffers, with the secondary insurances jumping on the wagon to get their share of the monies.
When considering hiring a compliance officer or consultant, keep in mind that many know compliance and others may know chiropractic. It is imperative that you hire a certified compliance specialist who knows the operation, documentation, and coding for chiropractic. The compliance officer will aid in rectifying problems prior to an audit. By bringing each office into compliance each physician will ultimately help to improve the quality of health care for all of our patients and simultaneously ensure the future of chiropractic.
