Medicare DC’s Being Watched
Every Move You Make: Medicare Providers Are Being Watched
I probably wasn’t the only DC paying close attention when an unprecedented Department of Health and Human Services study, reported in USA Today in late April, found that over 36,000 chiropractors were paid nearly $500 million by the federal government in 2012, making chiropractors one of the largest groups of Medicare providers.
You can bet that the Office of the Inspector General (OIG) sat up and took notice as well.
At the center of the story was one Brooklyn chiropractor who received more than $1 million in Medicare payments in that year alone. In the top 1% of all individual Medicare providers, he allegedly performed more than 42,000 procedures on over 2500 patients, a statistic he refuted by saying that he had eight DCs working for him who all used his identification number.
That could be true. But it still means those eight chiropractors would have averaged more than $110,000 in payments — higher than 99.8% of chiropractors in the Medicare data. This is a profession where standing out from the crowd isn’t exactly your best move.
As the USA Today story noted, CMS doesn’t forbid providers from using others’ identification numbers, but it’s simply not a great idea. Since Medicare payments are linked to your identifier number, allowing others to use it drives up your reported reimbursement figures, a practice that can result in a number that falls well outside industry norms—an almost instant red flag for auditors.
Heck, even the American Chiropractic Association was quoted as finding this doctor’s data “suspicious.”
My point isn’t about whether this particular doctor is fraudulent. My point is that, as an increasing number of news stories bear out, chiropractic Medicare providers in general and especially Medicare providers whose documentation, numbers, and coding fall outside the form are increasingly under scrutiny.
The Centers for Medicare and Medicaid Services (CMS) won’t comment on individual practitioners, but said in a statement that it has “cracked down on tens of thousands of health care providers suspected of Medicare fraud.” Heads up: chiropractors were twice as likely as other specialties to be investigated for felony-level fraud.
Since 1999, the OIG has cut off 152 chiropractic practices from federal health care reimbursement, including Medicare, because of felony convictions relating to health care fraud. During that same time period, 240 chiropractors and 145 chiropractic offices were prohibited from receiving federal funds because doctors either voluntarily surrendered their license or had their license revoked or suspended.
Bottom line: if your documentation isn’t impeccable if you are over-reliant on the same sets of codes if you are standing out in any way, you are increasing the likelihood of appearing on the OIG’s radar. To learn more about how to make your practice more audit-proof, drop us an email at firstname.lastname@example.org.
Dr. Ray Foxworth is a certified Medical Compliance Spe¬cialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation, and compliance. He has served as president of the Mis¬sissippi Chiropractic Association, former Staff Chiro¬practor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990, email@example.com or visit the ChiroHealthUSA website at www.chirohealthusa.com. Join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to www.chirohealthusa.com to register today.