Kansas Chiropractic Firm Accused Of Improperly Billing Medicare

Federal investigators say nearly all of the Medicare payments made to a Lawrence-based chiropractic group should not have been allowed.

Medicare paid Lawrence-based Advanced Chiropractic Services almost $765,000 for treatments in 2011 and 2012. An audit by the Department of Health and Human Services' Office of Inspector General (OIG) says almost none of those claims were legally allowable.

Advanced Chiropractic is based in Lawrence, with offices in Bonner Springs and Valley Falls. It was one of several companies selected for review after Medicare auditors looked at claims data for 2011. In 2011 and 2012, Medicare paid approximately $1.4 billion for chiropractic services provided to Medicare beneficiaries nationwide, according to the OIG’s report.

The audit, conducted from June 2013 through May 2014, follows a previous audit of 2006 chiropractic claims. That probe concluded that Medicare inappropriately paid an estimated $178 million out of $466 million reviewed for chiropractic services that were medically unnecessary, incorrectly coded or undocumented.

Medicare limits coverage of chiropractic services to manual manipulation of the spine to correct a “subluxation”, or misalignment of the spine. Depending on the number of spinal regions treated, chiropractors may bill Medicare using one of three codes. The procedure has to be labeled AT, for “acute treatment”, rather than maintenance therapy, for the claim to be paid.

According to the latest audit, Advanced Chiropractic Services, or ACS, collected Medicare payments for treatments to more than 22,000 Medicare beneficiaries in 2011 and 2012.

“The Medicare claim data that we reviewed showed that all of the chiropractic services provided by ACS were billed with the AT modifier. Further, almost all (98 percent) of the services were billed with CPT code 98942, which had the highest physician fee schedule amount among the three CPT codes covered by Medicare for chiropractic services,” the OIG report states.

Auditors sent 105 of those claims to a medical review contractor to determine whether the services were allowable for Medicare payment. The reviewers determined that the medical records failed to support any of those treatments as medically necessary.

Based on that sample, the auditors estimate that ACS was overpaid by at least $737,000 in that two-year period.

“These overpayments occurred because ACS did not have adequate policies and procedures to ensure that the medical necessity of chiropractic services billed to Medicare was adequately documented in the medical records,” the report states.

Advanced Chiropractic did not respond to a request for comment, but in written comments to the OIG, their attorney argued that the treatments were, in fact, medically necessary, and that the audit was flawed.

“ACS has not been engaged in any fraudulent or unethical billing practices,” the attorney, Steven Conway, said. “All of the services reviewed by OIG were actually provided to Medicare Beneficiaries. All of the services reviewed by OIG assisted in the functional improvement and relief of the Medicare beneficiaries' painful conditions.”

Conway also warned that requiring ACS to pay back the entire $737,000 could result in the closing of all three ACS offices.

“The initial OIG financial determination requesting a repayment equivalent of 96% of two years of Medicare payments will result in a devastating financial hardship on the clinics and the Medicare beneficiaries that they serve. ACS urges OIG to allow it to instead use its limited resources towards increased compliance programs and activities.”

Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.