Federal Insider: Medicare overpaid for most chiropractic services. Will patients have to repay?

Are you a Medicare recipient? Do you use a chiropractor?

If the answer is yes to both questions, it’s highly likely the federal government should not have paid for your services.

But don’t worry: You won’t have to pay Uncle Sam back.

Medicare is the federal health insurance program for the elderly and others with certain disabilities. It reimbursed chiropractors $438 million in 2013 for services to more than 17 million beneficiaries. About $359 million of that, approximately 82 percent, was wrongly paid, according to the Department of Health and Human Service’s Office of Inspector General (IG).

Although the report released last week covers 2013, it provides no indication that the Centers for Medicare and Medicaid Services (CMS) that runs Medicare is doing a better job now. In fact, the report issued by Inspector General Daniel R. Levinson includes this warning: “Unless CMS implements strong controls, it is likely to continue to make improper payments to chiropractors.”

Many people with back pain see chiropractors because they specialize in spinal manipulation. Medicare covers that, but only for active or corrective treatment of spinal subluxation or misalignment. Medicare does not consider maintenance therapy necessary, so the government will not pay for that. Maintenance therapy can prevent deterioration of some conditions.

Responding to the report, the American Chiropractic Association said it believes “the definition of maintenance care is ambiguous, that it is unclear how this definition was used to audit chiropractic records in the context of this specific report and that further research should be conducted to determine the medical necessity of maintenance care, which preliminary studies indicate may actually be of benefit to older adults.”

Levinson’s office investigated the chiropractic charges because a series of previous reports found ongoing problems with the payments. Four reports from 2013 to 2016 “found that Medicare made improper payments for chiropractic services that were medically unnecessary, incorrectly coded, insufficiently documented, or not documented,” the new report said.

For this report, the IG reviewed a sample of 105 chiropractic services. Only 11 “were allowable in accordance with requirements,” the IG said. That means almost nine out of 10 were not. The documentation provided by the chiropractors in the sample “did not support the medical necessity of the services,” the IG found.