Back problems, muscle aches, neck pains and more can all be appropriately addressed by a qualified chiropractor. But chiropractic fraud is more common than it should be and prevents many patients from getting the help they need. What is more, chiropractic fraud can even exacerbate an existing issue, or cause other medical problems down the road. Chiropractic fraud also helps deceitful individuals flourish in the medical field. It also drains down available Medicare and Medicaid reimbursement funds that all taxpayers have paid into.
If you’re worried about chiropractic fraud, you may be able to report it to a healthcare fraud lawyer and put a stop to it. Patients, healthcare office workers, qualified practitioners, and anyone with insider information may be able to blow the whistle on chiropractic fraud and prevent put an end to schemes that put profits over people in pain.
What is Chiropractic Fraud?
Chiropractic fraud can take many forms, including improper billing, failing to examine or treat patients properly, or otherwise attempting to manipulate patients for financial gain. According to the Centers for Medicare & Medicaid Services’ (CMS’s) Comprehensive Error Rate Testing program which tracks improper Medicare payments and fraud alerts annually, chiropractic services have the highest improper payment rates among Medicare Part B services over a five-year period. Improper payments for chiropractic services range from 43.9% to 54.1%, costing the taxpayer up to $304 million in overpayments during the period examined.
Furthermore, chiropractic Medicare fraud flourishes under Medicare Part C, where private insurance companies provide reimbursement for patients’ treatments and then pass along the cost to Medicare programs. With less oversight in place and the need to rely on private insurance companies for reporting, many sessions and alternative therapies that should never be covered by taxpayer dollars are paid without question.
Common Types of Chiropractic Insurance Fraud
Chiropractic fraud whistleblowers are often qualified healthcare and insurance workers who can spot improper billing practices and other misrepresentations of care. The following are some common examples:
Upcoding and Overbilling Chiropractic Patients
Upcoding involves charging Medicare or Medicaid for more expensive services than those that were actually rendered. Upcoding is related to unbundling, when multiple services that should be charged under one code are instead separated into a series of separate payments to increase reimbursement totals. Both are all too common examples of overbilling practices that cost taxpayers hundreds of thousands of dollars each year.
Chiropractic Kickback Schemes
When chiropractors offer or accept kickbacks, they violate the Anti- Kickback Statute and can be held accountable under federal law with fines, fees, exclusion from future government reimbursements, and even jail time. Kickbacks are payments or benefits offered and/or received in order to induce new clients, continued services, or increased profits. They are not always offered in dollars and cents; kickbacks may also be discounts on pricing, free advertisement space, free office space, expensive dinners, hotel stays, airfare, or other attempts to sway decision making based on monetary gain.
Unlike in other industries, in healthcare, kickbacks are always illegal. An example of a chiropractic kickback scheme might be a chiropractor and a physical therapy clinic that have a financial arrangement to refer patients to each other. Both of the medical providers and their offices could be held accountable under the Anti-Kickback Statute for such an arrangement. When decision making is influenced by profit motive it jeopardizes the standard of overall patient care.
Billing for Medically Unnecessary Chiropractic Treatments and Adjustments
Some chiropractors have been known to bill for medically unnecessary services or tell patients they need to return for continued care when they should be finished with their sessions. In other cases, chiropractors committing fraud may bill for adjustments that they never offered to their patients, or bill intake appointments as if they are full treatments.
Billing Medicare for Maintenance Therapy
Reporting from the Department of Health and Human Services Office of the Inspector General shows that approximately 40 to 47% of all paid Medicare chiropractic claims were for maintenance therapy. Maintenance therapy is when further clinical improvement capacity has already been reached, and continued treatments cannot be expected to improve a patient’s situation.
Medicare currently only covers “active treatment” chiropractic services, which is chiropractic visits aimed at improving patient function. Billing for and receiving Medicare insurance reimbursements for maintenance therapy sessions is considered fraud, and should not be covered by taxpayer funds under the current policy.
Signs of Chiropractic Insurance Fraud
Patients may also be able to spot chiropractic insurance fraud by voicing their concerns about unscrupulous providers, or practices aimed at taking advantage of patients’ pain. While patients may have less insight into chiropractic insurance fraud charges, they may be able to speak up about any of the following red flags:
- High up-front costs: Chiropractic visits should not involve high up-front costs in order to be seen by the practice. Especially when your chiropractor’s office accepts insurance, asking for payments other than your regular co-payment should raise alarm bells that something may not be right.
- Fearmongering: Many patients come to chiropractors’ offices because they have been driven by extreme or chronic pain that can cloud their decision making. A chiropractor that makes unrealistic promises or attempts to sway your choices by preying on that pain should be reported for providing improper care.
- Requests daily visits: Chiropractors, like all other medical practitioners, are not miracle workers and can only offer a certain amount of benefit to patients. Requests for what seem like an excessive amounts of visits and adjustments may be a warning sign that your chiropractor is seeing you mainly to overbill your insurance for reimbursements. According to one OIG study, after 12 chiropractic treatments in one year, it becomes increasingly likely that the services being offered were not medically necessary.
- Your pain is not being addressed: If your condition is not improving or is actively being made worse by chiropractic visits, speak to a healthcare fraud attorney. There may be other patients who are in a similar situation as you are. Speaking up can prevent a deceitful practice from profiting off of the pain that they may be causing.
- Bills for treatment which was never administered to or needed by a patient: Chiropractors are limited by what they can charge, especially for patients who are receiving what is known as “maintenance therapy.” Billing for nonstandard practices or continued care in some situations may be an example of fraud.
Who Investigates Chiropractic Fraud Claims?
When chiropractors and health care providers receive government funds in the form of Medicare or Medicaid reimbursements they can be held accountable via the False Claims Act. Healthcare fraud is investigated by the Department of Justice and federal officials with CMS and the Office of Health and Human Services. Claims from whistleblowers and civil fraud qui tam lawsuits allowed federal investigators to recover over $2.2 billion in stolen taxpayer money during fiscal year 2022. From that total amount, over $1.7 billion was directly related to healthcare fraud.
How to Report Chiropractic Fraud
Anyone can speak up as a chiropractic fraud whistleblower, but the likeliest people to be able to report this kind of healthcare scam are employees at chiropractic offices or patients being seen by chiropractors.
If you need help speaking up, contact a chiropractic fraud lawyer. Our experts will be able to advise you about what kinds of proof are necessary in order to convince Medicare/Medicaid investigators to open a case. Our team can also help clarify what kinds of limitations and exceptions there are for sharing confidential health records in order to prove chiropractic fraud.
What Challenges Are there to Reporting Chiropractic Insurance Fraud?
One challenge to reporting chiropractic fraud is simply how widespread bad actors have become in the field. One audit from the Office of the Inspector General found that approximately 82% of the $438.1 million paid by Medicare for chiropractic services in one year was in fact unallowable.
Federal auditors share that in large part, chiropractic fraud escapes prosecution under the system because CMS does not have controls in place to prevent payments for medically unnecessary visits. Additionally, because many chiropractic services are not covered by Medicare reimbursements, providers may be incentivized to over-report or over-schedule the number of visits actually necessary, in order to increase their payouts. This booking frenzy can mask what actually takes place during the chiropractic sessions, and allow fraud to continue without repercussions.
Rewards for Chiropractic Fraud Whistleblowers
Despite the challenges in reporting and proving chiropractic fraud, whistleblowers have powerful incentives to come forward. Whistleblowers may be able to receive up to 30% of a successful chiropractic fraud lawsuit recovery. The False Claims Act creates liability at the rate of treble damages per false claim, allowing for large recoveries and substantial whistleblower rewards.
Are Chiropractic Whistleblowers Protected?
Chiropractic fraud whistleblowers receive federal protections against harassment, retaliation, or discrimination. If your employer reduces your hours or pay, passes over you for promotion, or discriminates against you in any other way because of your role in reporting fraud, you may be able to sue for the following:
- Double back pay, plus interest
- Reinstatement
- Front pay, in cases where reinstatement is not possible
- Legal fees and damages
Notable Chiropractic Fraud Cases
The Department of Justice has been cracking down on chiropractic fraud cases and abuse of healthcare funds. The following are some notable chiropractic fraud cases involving whistleblower action and a recovery of lost or stolen taxpayer funds:
- Missouri Disability Fraud Chiropractor Case: A chiropractor’s clinic in Jefferson County, Missouri was accused of helping patients receive more than $3.5 million in fraudulent disability benefit payments through the Social Security Administration’s Disability Trust Fund as well as via private disability benefit insurance providers. The chiropractor charged non-disabled patients thousands of dollars for preparing disability forms on their behalf, as well as hundreds of dollars for annual appointments in order to continue to qualify for the public assistance payments. The chiropractor and staff at the office allegedly coached patients on how to lie to insurance adjustors about their ability to perform basic actions such as sitting, standing, and walking. The chiropractor, employees, and patients all faced charges in the case.
- Underreported Tax Payments from Maryland Chiropractor: A Maryland chiropractor who had been in business for over 20 years was convicted of filing fraudulent returns with the IRS and avoiding tax payments. From 2009 through 2015, the chiropractor filed income tax returns that did not report his chiropractic business and fraudulently claimed no earned business income, while continuing to receive insurance reimbursements and charging patients for services rendered. Evidence at trial showed that in fact the chiropractor received total payments of over $350,000 during the period in question.
- Second Highest Chiropractic Medicare Biller in California Pleads Guilty to Healthcare Fraud: In a case that illustrates the widespread nature of chiropractic fraud, the second highest biller in California for reimbursements in chiropractic services was caught billing for patients never treated or seen by the clinics. The owner of the chiropractic chain located in strip malls allegedly submitted over $1.7 million in false and fraudulent claims to Medicare, and received just over $1 million in taxpayer dollars. The San Fernando Valley chiropractor also staged an early morning carjacking in order to report to auditors that the nonexistent patient files were stolen, in an effort to avoid repayment.
- Iowa Chiropractor Accused of Medical Device Fraud: One Iowa chiropractor, along with his wife, the chiropractic clinic’s co-manager, have been accused of Medicare fraud exceeding $1 million. The scam involved billing Medicare for a non-covered device, the “P-stim”. The electro-acupuncture device was billed to Medicare as if it were a surgically implanted neurostimulator valued at $6,000. In actuality, each P-stim was valued at $667 and was affixed behind a patient’s ear until the battery ran out, at which point it was discarded. The chiropractor was also accused of pressuring clinic employees to market the electrical device to patients, even those who did not want it or who did not want to continue using it.
Report Chiropractic Fraud Today
If you have concerns about chiropractic fraud, report them to a healthcare fraud attorney today. You can save taxpayers millions of dollars each year by reporting scams, false reporting, overbilling, and bad actors in the chiropractic field. Whistleblowers are eligible to earn financial rewards of up to 30% of a successful chiropractor fraud settlement in certain situations, as well as protections against employer retaliation. Contact our experts today for a complimentary, confidential legal consultation about the facts of your case.