The Office of the Inspector General ( OIG ) of the Department of Health and Human Services ( HHS ) has the responsibility of auditing the results of the various programs providing public services including the Medicare and Medicaid programs. For years the Centers for Medicare and Medicaid Services (CMS) has criticized the chiropractic profession based upon Comprehensive Error Rate Testing (CERT) results indicating that over 40% of paid chiropractic claims are associated with maintenance care and are therefore inappropriate. The problem has been frequently cited in reports to Congress and in a bill passed in April 2015, the chiropractors were once again targeted for extreme measures.
The most recent OIG report, however, reveals that much of the criticism from CMS may be highly exaggerated. The 2015 OIG report statistically analyzed 100% of the paid chiropractic claims from 2013 ( 19,671,262 claims) and found that while there was an obvious potential problem with paid claims from 962 chiropractors ( out of 45,490 ), “… just 3% of the claims for all other chiropractors paid by Medicare in 2013 were suggestive of maintenance therapy”.
After reviewing the 2015 study (see Summit Presentation) it is difficult to come to any conclusion other than that the chiropractic profession is being unfaily targeted by Congress and that ultimately it will be the chiropractic patients that will unfairly pay the price.