Fraud in chiropractic care is on the rise as cases of unscrupulous billing practices and abusive care increasingly come to light, according to a Dallas-based analytics company that identifies fraud, waste and abuse by investigating self-funded employers’ healthcare claims.
A shocking 82 percent of the chiropractic services billed to Medicare is unallowable, according to a recent audit by the Office of Inspector General. The audit found a lack of effective controls allowed an estimated $358.8 million in taxpayer funds to be improperly billed to Medicare.
In the United States, billions of dollars are wasted every year on fraudulent or unnecessary medical care.
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How Do Chiropractors Commit Fraud?
Chiropractors engage in fraudulent billing practices in a variety of ways, targeting different groups of people. Sometimes they target environments like nursing homes or substance abuse rehabilitation centers, looking for new patients who may – or may not – require their services.
In one case, the Dallas analytics company discovered that a St. Louis-based chiropractor bribed police officers to get access to personal information about individuals who had been in car accidents. The chiropractor then contacted the accident victims and claimed to be from an insurance company or the state to arrange appointments at his practice. The chiropractor also collaborated with lawyers who sued the insurance companies after accidents or aligned himself with pain management physicians, providing kickbacks to the lawyers and doctors who sent patients his way.
In another case, a Houston-based chiropractor and his medical group settled with the federal government for $2.6 million and were also banned from billing federal programs for 10 years due to their involvement with a fraudulent billing scheme. The scheme involved neurostimulator electrodes that the practice was not authorized to administer.
Lastly, in 2021, a chiropractor based in Orange County, California, was found guilty of federal criminal charges, including five counts of healthcare fraud. The chiropractor was accused of defrauding health insurers by submitting $2.2 million in billings for chiropractic services that were never provided, office visits that never occurred, false diagnoses, and falsely prescribed medical devices.
These are just a few of the fraud cases among chiropractors that have come to light in recent years.
Why is Fraud on the Rise Among Chiropractors?
Although other medical specialties also have bad actors, certain specific reasons can be identified as to why fraudulent billing and abuse have been increasing among chiropractors. These practitioners have fewer lower-cost codes to bill for, which means they need more patients to boost their earnings. For example, a service may only be billed at $25 or $50, but if this is billed to every patient on every visit, it quickly adds up. Because employers often have limited resources, it’s easy for minor charges to go unnoticed.
According to a 2018 report, the inspector general has conducted numerous evaluations and audits of chiropractic services since 2005 and has identified hundreds of millions of dollars in overpayments for services that did not meet Medicare requirements. The report also noted that the OIG’s investigations and legal actions involving chiropractors have demonstrated that chiropractic services are susceptible to healthcare fraud.
How Do We Fight Fraud Against the Government?
Seek justice on behalf of taxpayers with the help of our experienced attorneys. Our Dallas, Texas, whistleblower team has battled corporate giants for 20 years, aggressively fighting to hold corporations, individuals, and other entities accountable for fraud committed against the government. If you believe you have a whistleblower case, we can help.