American Chiropractic Association Responds
to the May 2009 OIG Report

This section was compiled by Frank M. Painter, D.C.
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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, or undocumented.

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 reviewers.

“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 chiropractic claims.

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

For more information and to view ACA’s full response to the 2009 OIG Report, read our copy of: (36 page PDF)

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