Medicare: May 2009 OIG Report


In May of 2009, the Department of Health and Human Services Office of Inspector General (OIG) released the Report “Inappropriate Medicare Payments for Chiropractic Services” (OEI-07-07-00390). The objectives stated in the Report were to determine the extent to which: 1) chiropractic claims allowed in 2006 for beneficiaries receiving more than 12 services from the same chiropractor were appropriate, 2) controls ensured that chiropractic claims were not for maintenance therapy, 3) claims data can be used to identify maintenance therapy, and 4) chiropractic claims were documented as required.

The OIG came to four conclusions: 1) Medicare inappropriately paid $178 million out of $466 million for chiropractic claims in 2006, 2) Efforts to stop payments for maintenance therapy have been largely ineffective, 3) Claims data lack information to identify maintenance therapy, 4) Chiropractors often do not comply with Medicare documentation requirements. 

It is the opinion of the American Chiropractic Association that the May 2009 OIG Report fails to provide the information necessary to evaluate the appropriateness of the claims review methodology they used to arrive at key conclusions regarding the level of inappropriate Medicare payments to doctors of chiropractic. It is probable that the methods used resulted in an overestimate of inappropriate claims paid. Further, the ACA feels that the window of time between the release of the 2005 OIG Report and the initiation of data collection in 2006 for this Report did not allow sufficient time for meaningful change to occur within the chiropractic profession, and that it is too soon to conclude that efforts to stop Medicare payments for maintenance care have been unsuccessful. Numerous chiropractic organizations took immediate action to address issues of documentation standards and maintenance care in 2005 and we believe that significant progress has been made since that time. This premise is supported by the fact that 1) the documentation error rate identified in the 2009 OIG Report was significantly lower than that presented in the 2005 Report  and 2) CMS CERT Reports saw a drop in overall error rates from 16 percent in 2006 to 11 percent in 2007 for chiropractic services.