With about 31 million Americans suffering from back pain, according to a New England Journal of Medicine study, it's no surprise that Medicare payments for chiropractic services have grown dramatically. But an audit report released Tuesday by HHS' inspector general found that nearly 67% of all Medicare payments for chiropractic services in 2001 were improper, costing the program and its beneficiaries $285 million.
The amount Medicare has paid for chiropractic services grew from $255 million to cover 11.2 million services in 1994 to $683 million for 21 million services in 2004. In 1970, there were 13,000 licensed U.S. chiropractors, a figure that has more than tripled to 50,000 in 2000, according to the U.S. Labor Department.
The 39-page report, "Chiropractic Services in the Medicare Program: Vulnerability Analysis," said more than two-thirds of the services Medicare paid for in 2001 were miscoded, undocumented or failed to meet Medicare coverage criteria. Some 94% of the claims in a random sample of chiropractic claims lacked one or more of the required supporting documents. Medicare-hired chiropractors reviewing the claims found that 55% of those services were medically unnecessary.
The report indicated that as beneficiaries increase their use of chiropractic services, the CMS and its fiscal carriers must strengthen their oversight and control over payments. The inspector general found in previous reports "a significant vulnerability existed in connection with chiropractic services, particularly considering maintenance care." Medicare doesn't pay for maintenance care.
The CMS generally agreed with the report's findings and said its carriers have stepped up oversight of chiropractic claims and launched education efforts.