Medicare Overpaid Chiropractors by Nearly $285M in 2001, OIG Report Says

Medicare in 2001 reimbursed chiropractors for nearly $285 million in services that "should not have been billed to Medicare," an HHS Office of Inspector General report released Tuesday said, the AP/Chicago Sun-Times reports.

According to the AP/Sun-Times, Medicare reimburses chiropractors for manipulation of the spine intended to improve a chronic or acute condition. However, Medicare policy specifies that the program should not reimburse chiropractors for maintaining a health condition.

In 2001, $2 out of every $3 in Medicare spending on chiropractic services was questionable because the services provided failed to meet the government's criteria for medical necessity or providers did not properly document necessary services. In 2001, most of the improper payments -- $251 million -- made to chiropractors were for maintenance services, according to OIG.

"The need for a more effective way to eliminate inappropriate maintenance payments is crucial," the report says, adding that caps should be placed on the number of times Medicare can be billed for chiropractic services for a beneficiary. "When chiropractic care extends beyond 12 treatments in a year, it becomes increasingly likely that individual services are not medically necessary," the report says.

However, the American Chiropractic Association said the data cited by OIG is now four years old, adding that the government in 2004 established new procedures to help chiropractors avoid improper billings.

ACA lawyer Thomas Daly said, "The procedures were put in place not quite a year ago, and it's intended to address the very problem they're talking about in this report. They wouldn't have the statistics to report whether it's having an impact or not. That's why we're a little mystified why they didn't go into what's happening now." Daly added that ACA disagrees with OIG's recommendation that Medicare cap the number of times it could reimburse for chiropractic services (Freking, AP/Chicago Sun-Times, 6/22).

The report is available online. Note: You must have Adobe Acrobat Reader to view the report.

Several other media sources recently published stories related to Medicare. Summaries of the articles appear below.

• CQ HealthBeat: Panelists at a forum sponsored by the Brookings Institution on Monday said that health care costs will continue to rise in the coming years, putting even greater financial pressure on Medicare and Medicaid. Rudolph Penner, a senior fellow at the Urban Institute and former director of the Congressional Budget Office, said that the Medicare program as currently designed is "really unsustainable." Henry Aaron, a senior fellow at the Brookings Institution's Economic Studies Program, added, "The combination of increasing per capita spending and an increasing number of capitas ... would cause a quadrupling of the share of the gross domestic product from just (Medicare and Medicaid)" (CQ HealthBeat [1], 6/21).
  
  
• CQ HealthBeat: Treatment of Medicare beneficiaries with Alzheimer's disease will improve as a result of the 2003 Medicare law because of a wider availability of "special-needs" managed care plans, CMS Administrator Mark McClellan said Tuesday at a conference hosted by the Alzheimer's Association. Special-needs plans screen for dementia and monitor patients with the condition carefully to prevent development of more costly complications. Currently, there are 50 such plans, but McClellan predicted that the number will increase to 150 in 2006 because of a new policy allowing plans to enroll dual eligibles and nursing home residents. In addition, CMS can designate plans to treat other populations with severe or disabling chronic conditions (CQ HealthBeat [2], 6/21).
  
  
• CQ HealthBeat: A rule that governs which providers qualify as inpatient rehabilitation facilities does not need to be revised, despite a recent Government Accountability Office report that said the rule needed refining, CMS said Tuesday. Under the rule, a facility qualifies as an IRF if 75% of its patients need intensive rehabilitation for one of 13 medical conditions. Facilities that provide rehabilitation care seek IRF status because they would qualify for higher Medicare payments. Implementation of the rule, which was announced in May 2004, was delayed pending the GAO study, which made a series of recommendations for improving how facilities are classified as IRFs. CMS said it already has implemented GAO's recommendations. A formal announcement that the regulation will go forward will be published in the Federal Register on June 24 (CQ HealthBeat [3], 6/21).
  
  
• New Orleans Times-Picayune: The Times-Picayune examined the federal government's "aggressive enrollment campaign" for the new Medicare prescription drug benefit, which begins Jan. 1, 2006 (Walsh, New Orleans Times-Picayune, 6/22).
  
  
• Springfield Republican: The Republican examined Medicare's finances (Moriarty, Springfield Republican, 6/21).