Actions included revocation of billing privileges, implementation of prepayment reviews, referral to law enforcement and suspension of payments.
CMS states they discovered/prevented more than $210,000,000.00 of improper Medicare ‘fee for service’ payments with their new ‘state of the art’ fraud prevention system. This equates to double that of last year and proves to them the efficacy of increasing utilization in the future.
One highly publicized case, known to many chiropractors, was a group practice identified as a ‘high risk for inappropriate billing’. They were surprised by an unannounced site visit that showed the aides were not qualified to deliver services.
They removed the doctor from the Medicare program and prevented $700,000 of Medicare payment from being honored.
Most actions against chiropractors are relative to the physician not releasing the patient from active care when active care can no longer be justified via appropriate documentation. Remember, patients are to be issued an ABN form and released from active care when such can no longer be documented to Medicare’s standard. This standard has nothing to do with a chiropractic definition of “maintenance care”.
All practitioners are required to understand the proper use of an ABN form and audit such, with an appropriate audit tool, annually-at a minimum. Action steps should be taken to remedy deficiencies.
About: For more information on proper use of ABN forms/audits or HIPAA compliance questions, please contact Dr. Ty Talcott, CHPSE, at HIPAA Compliance Services – a company dedicated to protecting healthcare professionals by producing simplified “how to” step-by-step training materials and procedures to assist doctors and clinic support personnel with establishing, maintaining and updating their HIPAA compliance program.