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Etheredge Chiropractic Received Unallowable Medicare Payments for Chiropractic Services

Some chiropractic services that Etheredge billed were not allowable in accordance with Medicare requirements. Of the 100 chiropractic services in our sample, 67 were allowable in accordance with Medicare requirements. However, the remaining 33 were not allowable: 31 services were medically unnecessary and 2 were not documented. As a result, Etheredge received $1,042 in unallowable payments. On the basis of our sample results, we estimated that Etheredge received unallowable Medicare payments of at least $169,737 for 2014 and 2015. As of the publication of this report, this unallowable amount includes claims outside of the 4-year claims reopening period.

Etheredge disagreed that 31 claims were medically unnecessary. It stated that it would go through the Medicare Part B appeals process. We maintain that our audit results are valid because we, with the assistance of an independent medical reviewer, determined whether each service was allowable in accordance with Medicare requirements.

Filed under: Center for Medicare and Medicaid Services