An estimated $358.8 million, or approximately 82 percent, of the $438.1 million paid by Medicare for chiropractic services in 2013 went to medically unnecessary procedures, according to a recent audit report from HHS' Office of Inspector General.
For the audit, the OIG reviewed 105 sampled chiropractic services, 11 of which were allowable in accordance with Medicare billing requirements. The remaining 94 services were not allowable because they were medically unnecessary.
Among the OIG's recommendations are: That CMS determine a reasonable number of chiropractic services that are necessary to treat spinal subluxation and monitor the system to identify services that may be superfluous; determine a reasonable limit for the number of chiropractic services that Medicare will reimburse and implement a system edit to disallow services in excess of that limit; and improve education of chiropractors on Medicare coverage requirements for chiropractic services and the proper use of the AT [Acute Treatment] modifier to ensure that only medically necessary chiropractic services are billed to Medicare.
CMS Acting Administrator Andy Slavitt, in a letter responding to the OIG's review, rejected the OIG's recommendation for a numerical limit on chiropractic care, saying CMS does not know of medical evidence that supports the move, according to The Wall Street Journal. However, in recent years, CMS has wanted to clarify for chiropractors what they are allowed to do in terms of what they can bill to Medicare, Mr. Slavitt said, according to the report. In 2011, the report adds, CMS also started using algorithms to monitor for fraud.