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Medicare Needs Better Controls To Prevent Fraud, Waste, and Abuse Related to Chiropractic Services

Issued on  | Posted on  | Report number: A-09-16-02042

Report Materials

This portfolio presents an overview of program vulnerabilities identified in prior Office of Inspector General audits, evaluations, investigations, and legal actions related to chiropractic services in the Medicare program. It consolidates the findings and issues identified in that work and discusses recommendations from prior reports that have not been implemented or have been implemented ineffectively. In addition, this portfolio provides information to help the Centers for Medicare & Medicaid Services understand the need for effective controls over chiropractic services and offers recommendations to help Medicare prevent fraud, waste, and abuse related to those services.

18-A-09-065.01 to CMS - Closed Implemented
Closed on 08/08/2019
We recommend that CMS work with its contractors to educate chiropractors on the training materials that are available to them.

18-A-09-065.02 to CMS - Closed Implemented
Closed on 10/22/2018
We recommend that CMS educate beneficiaries on the types of chiropractic services that are covered by Medicare, inform them that massage and acupuncture services are not covered by Medicare, and encourage them to report to CMS chiropractors who are providing non-Medicare-covered services.

18-A-09-065.03 to CMS - Closed Unimplemented
Closed on 02/01/2019
We recommend that CMS identify chiropractors with aberrant billing patterns or high service-denial rates, select a statistically valid random sample of services provided by each chiropractor identified, review the medical records for the sampled services, estimate the amount overpaid to each chiropractor, and request that the chiropractors refund the amounts overpaid by Medicare.

18-A-09-065.04 to CMS - Closed Unimplemented
Closed on 02/01/2019
We recommend that CMS establish a threshold for the number of chiropractic services beyond which medical review would be required for additional services.

View in Recommendation Tracker