OIG Report: Medicare Needs Better Controls to Prevent Fraud, Waste, and Abuse Related to Chiropractic Service

The Centers for Medicare & Medicaid Services’ (CMS's) Comprehensive Error Rate Testing program, which measures improper Medicare fee-for-service payments annually, identified chiropractic services as having the highest improper payment rates among Medicare Part B services from 2010 to 2015. The improper payment rate for chiropractic services ranged from 43.9 percent to 54.1 percent, and the estimated overpayments per year ranged from $257 million to $304 million. Further, since 2005, the Office of Inspector General (OIG) has conducted numerous evaluations and audits of chiropractic services and identified hundreds of millions of dollars in overpayments. Despite these findings, CMS has not implemented or effectively implemented all of our recommendations, and controls over chiropractic services remain inadequate to prevent fraud, waste, and abuse. This overview of Medicare program vulnerabilities identified in prior OIG audits, evaluations, investigations, and legal actions related to chiropractic services illustrates the need for better controls over those services to protect the Medicare Trust Funds, help reduce the risk of fraud, and prevent beneficiaries from paying millions of dollars in coinsurance for chiropractic services that are not reasonable or necessary. Further, chiropractic services that are not reasonable or necessary can potentially harm Medicare beneficiaries.