The U.S. government has estimated that Medicare spends hundreds of millions of dollars on medically unnecessary chiropractic services. In order to fight health care fraud like this, the U.S. pays whistleblowers a reward based on the amount it recovers through the False Claims Act from their information.
If you have evidence of Medicare fraud by a chiropractor, call 1-800-590-4116 for a free, confidential initial legal consultation with one of our whistleblower attorneys.
A study of chiropractic services by OIG discovered the highest rate of improper payments for Part B services in 2013. The OIG review of a sample of claims for payment for chiropractic services found that the majority were medically unnecessary. Of 105 claims from chiropractors reviewed, only 11 were allowed by Medicare’s requirements. OIG estimated that 82 percent of Medicare’s $438 million for spending on chiropractors was improper – in other words – most likely fraud.
Medicare Part B covers services by qualified chiropractors where the services are reasonable and necessary for the treatment of an illness or injury. These services are limited to manual manipulation of the spinal bones to correct misalignment. It does not cover maintenance therapy. Centers for Medicare and Medicaid Services (CMS) states that maintenance therapy is when further clinical improvement cannot be reasonably expected. Although Medicare does not put a limit on the number of covered services for a beneficiary, two MACs limit reimbursement to 25-30 per year.
The False Claims Act
The False Claims Act imposes substantial penalties on doctors, hospitals and other health care companies engaged in fraud while rewarding whistleblowers for providing evidence of the misconduct to the Justice Department through a qui tam lawsuit.
Our Federal False Claims Act lawyers have guided whistleblower cases to several significant settlements on behalf of relators. Our largest unsealed cases are currently focused on kickbacks in violation of the Anti-Kickback Statute, but we have a broad base of experience across other types of Medicaid and Medicare fraud. In the pursuit of suspected frauds, we have brought cases to the attention of the government in many states, including New York, Florida, California and here in Philadelphia. In 2016, for example, we helped the federal and state governments recover $54 million from a Valeant subsidiary for kickbacks paid through speaker programs.
The law rewards whistleblowers for information with between 15 and 30 percent of the proceeds from the litigation, subject to numerous terms and conditions specified in the law. During President Obama's Administration, the U.S. paid out more than $4 billion to whistleblowers. For those not familiar with whistleblower cases, we have written a quick guide to the process.
Our False Claims Act attorneys undertake a thorough review of whistleblower evidence up front during the case evaluation process. We confirm that there is sufficient evidence of both inappropriate government billings as well as evidence of intentional or reckless conduct by the individuals in charge. We understand that no one person needs to have every piece of the puzzle and we have evaluated thousands of potential cases while honing our judgment. We also answer any questions that a whistleblower has in order to ensure that you can make an informed judgment about whether to proceed with a qui tam lawsuit.
To begin the process and get your questions answered, use our contact form or call 1-800-590-4116 for a free, confidential and no-obligation initial legal consultation from our whistleblower attorneys.