The Sep 2015 OIG Report:  CMS Responds
Written by Editor   
Monday, November 16, 2015 07:11 AM

In September of 2015 the Office of the Inspector General (OIG) of the Department of Health and Human Services, a federal agency, released a report highlighting its evaluation of chiropractic claims and questionable and inappropriate payments for chiropractic services. This FINAL article looks at the CMS responses to the OIG’s recommendations.

OIG Recommendation:  Establish a more reliable control for identifying active treatment.

CMS Response:  CMS does not concur with this recommendation.  CMS acknowledges the issue but notes that there are significant obstacles to developing a reliable control for active treatment.  CMS will implement a program to prior authorization medical review of certain services provided by chiropractors as required by the Medicare Access and CHIP Reauthorization Act (MACRA).  CMS believes this program will help to address the concerns OIG identifies in this recommendation.


OIG Recommendation:  Develop and use measures to identify questionable payments for chiropractic services.

CMS Response:  CMS concurs with this recommendation.  CMS regularly develops measures to identify improper payments and takes appropriate action on the payments identified.  Currently, CMS has several chiropractic models that analyze claims to detect fraud, waste and abuse.  CMS will reexamine its models to look for opportunities for improvement or extension.


OIG Recommendation:  Take appropriate action on the chiropractors with questionable payments.

CMS Response:  CMS concurs with this recommendation.  MACRA authorizes CMS to conduct post payment review of certain services provided by chiropractors.  CMS will consider the referrals provided by OIG when developing plans to conduct post payment review under MACRA.


OIG Recommendation:  Collect overpayments based on inappropriately paid claims.

CMS Response: CMS concurs with this recommendation.  CMS will conduct a preliminary analysis of the claims submitted by providers once we received he list of providers from OIG.  Based on the analysis, CMS will determine the appropriate claims to more closely review and take appropriate act as needed.


OIG Recommendation:  Ensure that claims are paid only for Medicare-covered diagnoses.

CMS Response:  CMS concurs with this recommendation.  CMS will work with the Medicare Administrative Contractors (MACs) to make certain that chiropractic claims are paid only for diagnosis codes that meet Medicare coverage requirements.


Source: http://oig.hhs.gov/oei/reports/oei-01-14-00200.pdf