Chiropractor penalized $79,919 for violating the False Claims Act
According to the Department of Justice (DOJ) and the US Attorney’s office for the Northern District of Iowa, an Iowa chiropractor was penalized $79,919 for violating the False Claims Act. He did what thousands of DCs do every day... provided free therapy to a Medicare patient. The Government’s viewpoint was that this was done in an effort to influence the patient to continue to receive chiropractic adjustments from him. Two big no-nos were rolled into one bad day for this doctor: his conduct was in violation of both the Anti-Kickback Statute AND the False Claims Act.
Why Do Those Statutes Apply?
The Anti-Kickback Statute and False Claims Act regulations are in place to protect patients and federal health programs from healthcare fraud and abuse. A big part of that regulation ensures that the provider’s approach to patient care does not sway or cloud the judgement of a patient into receiving specific services or care from providers.
At KMC University, we’ve taught this for years. Even one free service to a Medicare patient can place a provider squarely in the cross-hairs of Government investigation. Consider that this doctor MAY have provided medically necessary chiropractic adjustments. That was not even the issue. The government’s concern was the influence that free e-stim caused for that patient. And now the doctor must pay back what he was paid on the adjustments.
As you might imagine, violations such as this result in another black eye for this profession. And of course, where funds for previously paid claims are recovered, this provides additional incentive to focus the magnifying lens just a bit closer on similar type claim submissions. Further, the OIG (Office of Inspector General) has recently released an eye-opening report regarding chiropractic billing and continual findings of fraud, waste, and abuse of federal programs. The OIG is a resource to all third-party payors as they work to combat what is considered to be a fraud, waste and abuse epidemic in healthcare.
What Does This Mean for Me?
First, evaluate your practice to ensure you don’t give away free services to federally insured patients, or any patients for that matter. If you wish to offer compliant discounts to those who are uninsured, under-insured, or partially-insured, like Medicare patients, consider ChiroHealthUSA (www.chirohealthusa.com). This network is associated with a Discount Medical Plan Organization (DMPO) and offers the exact solution for this type of situation. Next, take a proactive approach to documentation, coding, and billing compliance. Proper training is instrumental for the protection of you and your practice. You must have a qualified resource to help your practice when (not if) audits and payor related issues arise. KMC University is that resource for thousands of practices in the profession, complete with detailed training libraries for these very topics. And, as the largest team of certified specialists under one roof, someone is always at the ready for your on-demand support.
Let Us Help!
Don’t forget that compliance requires Chart Reviews at a minimum of once per year to show your effort to prevent fraud, waste, and abuse before it even happens. Now may be the best time for your practice to utilize the KMC University Professional 3 Chart Review. Learn more about our 3 Chart Review here.