Arlington, Va. June 10, 2009 -- In a response released today, the American Chiropractic
Association (ACA) refuted the findings and recommendations outlined in a May
2009 report released by the Department of Health and Human Services Office
of the Inspector General (OIG), noting the methods used by the OIG may have
resulted in an overestimate of inappropriate claims.
The recently released OIG Report, based on a sampling of claims data from
2006, concluded that Medicare inappropriately paid $178 million in
chiropractic claims for services considered maintenance therapy, miscoded,
In commenting on the report, ACA said the OIG’s decision to restrict data
collection to only those episodes of chiropractic care resulting in claims
of more than 12 visits by the same doctor, likely skewed the data pool by
focusing on a subpopulation previously identified to be more problematic. As
a point of comparison, an OIG report released in 2005 investigated data
collected from a global sample of claims.
“Based solely on this report, it is wrong to conclude that the services
rendered by doctors of chiropractic to Medicare beneficiaries are
unnecessary or inappropriate,” said ACA President Glenn Manceaux, DC. “It is
the opinion of the ACA that the report in question is at best fatally flawed
due to its reliance on distorted and misrepresented data.”
In addition, ACA’s response expressed concern regarding the standards used
to determine whether submitted files contained “complete” documentation, as
well as the amount of training provided to medical reviewers who were
charged with analyzing each claim. To better assess the report’s findings,
ACA has submitted a Freedom of Information Act request for copies of the
protocols, training tools, and credentialing standards used by medical
“While we support serious-minded efforts to ensure that funds within the
Medicare program are spent as efficiently as possible, we will not stand
idle and watch as data is twisted in an effort to discredit the thousands of
doctors of chiropractic across the nation that help millions of Medicare
patients every year,” Dr. Manceaux said.
Following a 2005 report, in which the OIG was highly critical of the
chiropractic profession’s participation in the Medicare program, a coalition
of chiropractic organizations, including the ACA, launched a multi-faceted
action plan to address the problems surrounding documentation and improper
use of maintenance care. Since its formation in 2005, the coalition has
accomplished the following actions:
The ACA made its documentation manual available to the profession at
cost over the course of two years. In addition, ACA developed and launched a
free educational webinar that provides doctors of chiropractic with tools
and information to improve their Medicare documentation.
The Association of Chiropractic Colleges tightened up documentation
standards requirements in chiropractic educational institutions, placing
added emphasis on Medicare requirements.
The Federation of Chiropractic Licensing Boards encouraged member boards
to require hours in documentation for re-licensure, and the Congress of
Chiropractic State Associations encouraged member associations to emphasize
Medicare and documentation educational seminars.
All four organizations met with the Centers for Medicare and Medicaid
Services (CMS) to discuss documentation requirements and attended a
presentation by CMS contractors regarding medical review standards for
ACA leaders feel the profession has made significant progress since the
aforementioned initiatives were implemented in 2006. “The impact of our
proactive actions is most certainly not reflected in this recent OIG report
because the window of time between the release of the 2005 report and the
start of the data collection in 2006 did not allow sufficient time for
meaningful change,” said ACA Chairman John Gentile, DC.
ACA plans to share its full response with Capitol Hill. The association
strongly encourages all doctors of chiropractic to work to improve their
documentation and understanding of the Medicare program. Resources are
available on ACA’s Web site at www.acatoday.org.
For more information and to view ACA’s full response to the 2009 OIG Report,