Medicare Spent $359 Million on Unnecessary Chiropractic Care

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http://www.wsj.com/articles/medicar...-care-in-2013-audit-finds-1476849782?mod=e2fb

All chiropractic care after the first 30 treatments was unnecessary, according to a federal review

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The Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt rejected the call for a numerical limit on chiropractic care. PHOTO: BLOOMBERG NEWS
By
MELANIE EVANS
Updated Oct. 19, 2016 6:23 a.m. ET

More than 80% of the money that Medicare paid to chiropractors in 2013 went for medically unnecessary procedures, a new federal audit found.

The federal insurance program for senior citizens spent roughly $359 million on unnecessary chiropractic care that year for treatment of strains, sprains or joint conditions, a review by the Department of Health and Human Services’ Office of Inspector General found.

The OIG called on the Centers for Medicare and Medicaid Services to tighten oversight of the payments, noting its analysis was one of several in recent years to find questionable Medicare spending on chiropractic care. “Unless CMS implements strong controls, it is likely to continue to make improper payments to chiropractors,” the OIG said.

While Medicare doesn’t limit how many times patients can see chiropractors, it should determine whether there should be a cutoff in visits, the OIG said. Medicare pays for active treatment, but not “supportive” care, or maintenance therapy. Patients who received more than a dozen treatments were more likely to get medically unnecessary care, the OIG found. All chiropractic care after the first 30 treatments was unnecessary, the review found.

CMS Acting Administrator Andy Slavitt, in a letter to the OIG in response to the review, rejected the call for a numerical limit on chiropractic care, saying CMS is unaware of medical evidence that supports the move. However, in recent years, CMS has sought to clarify for chiropractors what they can bill to Medicare, Mr. Slavitt said. The agency also began in 2011 to use algorithms to monitor for fraud. A CMS spokesman declined to comment beyond the letter.

John Falardeau, senior vice president of public policy and advocacy for the American Chiropractic Association, said the industry has “worked aggressively” to educate chiropractors on how to correctly document treatment and bill Medicare. “We’re committed to reducing waste and improving the quality of care in the Medicare system,” he said.

The group also rejects a numerical limit on chiropractic care, said Mr. Falardeau. “Every patient is different,” he said. “Some patients may require two visits; some may require more.”

Starting next year, some chiropractors will need Medicare to approve certain treatment before patients get care. Chiropractors with an “aberrant” pattern of billing and those with a high bill-rejection rate will be subject to the new scrutiny.

The OIG report was based on a random sample of Medicare spending for 105 chiropractic services in 2013. It included bills submitted to CMS through June 2014, which may exclude some chiropractic spending for 2013 because providers have up to 12 months after care is provided. Medicare audit contractors reviewed medical records for patients to determine whether treatment was medically necessary.

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CMS could save a lot more money if they just said 100% of chiro treatments are not medical care and then fired all the bureaucrats that investigated and reported on this. The 80% number has a nice, PC ring to it though. Did they really have to investigate this or did they have the number ahead of time?
 
Better to focus first on unnecessary spine surgeries, spine injections, spine imaging, opioids, and UDS. Much, much
bigger areas of waste.
 
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359 million is chump change. the total bill for medicare is as follows
//Medicare spending grew 5.5% to $618.7 billion in 2014, or 20 percent of total NHE. Medicaid spending grew 11.0% to $495.8 billion in 2014, ...//
 
359 million is chump change. the total bill for medicare is as follows
//Medicare spending grew 5.5% to $618.7 billion in 2014, or 20 percent of total NHE. Medicaid spending grew 11.0% to $495.8 billion in 2014, ...//


depends on this statement: "The OIG report was based on a random sample of Medicare spending for 105 chiropractic services in 2013."
so is that 359 million extrapolated for the entire medicare population? if so that's a pathetically small sample size with probably a huge variance
 
Plus Medicare cost evaluation is only a glimps into what chiro care costs commercial plans and health care at large. Add 30% for Medicare advantage plans
 
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