A Michigan Chiropractor Received Unallowable Medicare Payments for Chiropractic Services

A chiropractic clinic based in Michigan (Michigan Chiropractor) did not comply with Medicare billing requirements for 100 chiropractic service line items that we sampled. Specifically, the medical records did not support the medical necessity for 92 of the 100 sampled chiropractic services. On the basis of our sample results, we estimated that at least $339,000 of the $392,000 paid to the Michigan Chiropractor for chiropractic services in 2012 and 2013 was unallowable for Medicare reimbursement. These overpayments occurred because the Michigan Chiropractor did not have adequate policies and procedures to ensure that the medical necessity of chiropractic services billed to Medicare was adequately documented in the medical records.