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.